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Yuen EYN, Hale M, Wilson C. Experiences with health information among caregivers of people with cancer from culturally and linguistically diverse backgrounds: A qualitative study. Palliat Support Care 2024:1-9. [PMID: 38450449 DOI: 10.1017/s1478951524000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Although some research suggests that caregivers from culturally and linguistically diverse (CALD) communities have higher unmet information needs compared to their English-speaking counterparts, few studies have examined determinants of information needs among CALD cancer caregivers and their satisfaction with received information. This study aimed to explore experiences with cancer-related information among caregivers of people with cancer from CALD communities. METHODS Semi-structured interviews were conducted with 24 caregivers from Arabic and Chinese backgrounds (12 in each group). Thematic analysis was used to analyze data. RESULTS Participants' mean age was 40.6 years, and most were female (83%). Six themes were identified: (a) lack of information to meet their needs; (b) challenges understanding cancer- and care-related information; (c) proactivity to make sense of, and understand information; (d) interpreting information: the role formal and informal services; and (e) engaging with health providers to access information. CONCLUSIONS Caregivers identified significant language and communication barriers impacting their capacity to understand cancer-related information given by providers and they invested personal effort clarifying information. The importance of access to formal interpreter services, even when caregivers and care recipients seem proficient in English, was highlighted. Cultural sensitivity of providers when discussing a cancer diagnosis and treatment was also identified as an important consideration. SIGNIFICANCE OF RESULTS Culturally tailored outreach programs designed to provide key cancer-related information which are accessible to CALD caregivers have the potential to improve the health outcomes of both caregivers and care recipients.
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Affiliation(s)
- Eva Y N Yuen
- School of Nursing and Midwifery, Faculty of Health, Deakin university, Burwood, VIC, Australia
- Centre for Quality and Patient Safety-Monash Health Partnership, Institute for Health Transformation, Deakin University, Burwood, VIC, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia
| | - Megan Hale
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia
| | - Carlene Wilson
- School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
- Psycho-Oncology Research Unit, ONJ Centre, Austin Health, Heidelberg, VIC, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, VIC, Australia
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2
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Burke C, Doody O, Lloyd B. Healthcare practitioners' perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care 2023; 22:182. [PMID: 37978500 PMCID: PMC10655398 DOI: 10.1186/s12904-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/13/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Palliative care practitioners are increasingly caring for patients and families from diverse cultural backgrounds. There is growing awareness of the influence of culture on many aspects of care in the palliative phase of an illness. However, disparities have been noted in the provision of palliative care to patients from culturally diverse backgrounds and challenges have been reported in meeting their needs and those of their families. METHOD A qualitative systematic review of research papers identified through searching four databases. Papers were screened against inclusion criteria within the timeframe of January 2012 to March 2022. Data was extraction from all included studies and methodological quality assessed utilising the Critical Appraisal Skills Programme Tool. Thematic analysis followed Braun and Clarke's framework and the review is reported in line with PRISMA guidelines. FINDINGS The search yielded 1954 results of which 26 were included for appraisal and review. Four themes were identified: communication and connection, the role of the family in death and dying, the role of education in addressing uncertainty, and institutional and societal factors. The findings highlighted challenges of communication and a fear of acting in a culturally insensitive way, the pivotal role of the family, the need for an individualised approach to care, the universality of needs when approaching end of life and the need for education of practitioners. CONCLUSION These findings suggest that healthcare practitioners draw on their existing skills to adapt their practice to meet the needs of patients from culturally diverse backgrounds. However, results also indicate a need for further education and identification of educational approaches best suited to supporting healthcare professionals in practice.
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Affiliation(s)
- Colette Burke
- Milford Care Centre, Castletroy, Limerick, V94 H795, Ireland
| | - Owen Doody
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Barbara Lloyd
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, V94 T9PX, Ireland.
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Alsolami FN, Alharbi IM, Alsulami JN, Albohassan NS, Alfraidi LS, Alfares FA, Alsayafi SI, Abu Hajar MI, Alsheikh TY, Asad FM. Assessment of Knowledge and Attitudes Toward Palliative Care and End-of-Life Decision-Making in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e45781. [PMID: 37872898 PMCID: PMC10590645 DOI: 10.7759/cureus.45781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Palliative care in Saudi Arabia has witnessed significant recent progress through the establishment of the Saudi Society for Palliative Care and the National Palliative Care Program. The objective of this study was to assess knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces among individuals residing in these regions. METHODS Utilizing a cross-sectional survey-based research design, we assessed knowledge and attitudes regarding palliative care and end-of-life decision-making in Saudi Arabia's Eastern and Central provinces. Participants were recruited through purposive sampling via social media. Data collection included demographic information, palliative care knowledge, attitudes toward palliative care, and cultural influences on end-of-life decisions. RESULTS A total of 710 participants completed the survey, resulting in a response rate of 85%, with a balanced gender distribution, predominantly aged 25-54. Over half were healthcare providers, many possessing more than 15 years of healthcare experience. A substantial proportion had received formal palliative care training and had personal involvement in end-of-life decisions. While most participants demonstrated a good understanding of palliative care, knowledge gaps, especially regarding its timing, persisted. Generally, participants felt at ease discussing end-of-life care and believed in palliative care's effectiveness. Cultural influences on end-of-life decisions were perceived both positively and negatively, with some facing cultural challenges in palliative care. CONCLUSIONS This study underscores a promising understanding of palliative care in Saudi Arabia alongside persistent misconceptions. It highlights the necessity for targeted education to rectify misperceptions, particularly concerning the initiation timing of palliative care. Cultural factors strongly impact end-of-life decisions, emphasizing the need for culturally sensitive healthcare discussions and provider training.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Farah M Asad
- Public Health, Primary Health Care Center, Hofuf, SAU
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4
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Six S, Bilsen J, Deschepper R. Dealing with cultural diversity in palliative care. BMJ Support Palliat Care 2023; 13:65-69. [PMID: 32826261 DOI: 10.1136/bmjspcare-2020-002511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 01/29/2023]
Abstract
Palliative care is increasingly confronted with cultural diversity. This can lead to various problems in practice. In this perspective article, the authors discuss in more detail which issues play a role in culture-sensitive palliative care, why naive culturalism will not solve such problems and in which direction research into this aspect of care can be further elaborated.
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Affiliation(s)
- Stefaan Six
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
| | - Reginald Deschepper
- Mental Health and Wellbeing Research Group, Dpt. of Public Health, Vrije Universiteit Brussel-Brussels Health Campus, Brussel, Belgium
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Weerasinghe S. Inpatient end-of-life care delivery: discordance and concordance analysis of Canadian palliative care professionals' and South Asian family caregivers' perspectives. Palliat Care Soc Pract 2023; 17:26323524221145953. [PMID: 36643824 PMCID: PMC9837273 DOI: 10.1177/26323524221145953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023] Open
Abstract
Background End-of-life care involves a multitude of functions delivered by a team of healthcare professionals. Family caregivers get involved in every aspect of the palliative care journey. Meeting the needs of ethnically diverse patients can be a daunting task for Western-trained healthcare professionals. Family and professional caregivers need to have a mutual understanding of perspectives and expectations to integrate family caregivers into end-of-life care. The South Asian population in Canada is fast growing, and very little is known about their understanding and expectations of end-of-life care. Methods The purpose is to provide research-based knowledge on discordances and concordances of encounters and perceptions of end-of-life care delivery between South Asian family caregivers and palliative care health professionals. Individual interviews were conducted among seven palliative care professionals, in a tertiary care center, and seven South Asian family caregivers who have provided care, in the same inpatient center, for the same period. The constant comparison, a component of the grounded theory approach, was employed to compare the two types of caregivers' perspectives that emerged in the qualitative data. Findings The family caregivers were divided in their perception based on death denial and acceptance. The findings weaved the discordances and concordances of meaning assigned to palliative care to the three themes that emerged: the role of the family caregiver, communication needs and challenges, and barriers to the family caregiver participation in decision-making. The discordance between professionals and family caregivers arose in the death-denial group and concorded with the death-accepted group. The findings revealed a consequence of the survival optimistic bias, as creating dissatisfaction toward the end-of-life care delivery system when the palliative care professionals prognosticate imminent end-of-life. Conclusion The family caregivers' interactions and encounters were shaped by their acceptance or denial of the death of their family member in care. Gaining conceptual clarity on the meaning of palliative care and providing education on the process of end-of-life care delivery are crucial to integrating ethnically diverse family caregivers into the decision-making process.
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Gursahani R, Lorenzl S. International models of neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:73-84. [PMID: 36055721 DOI: 10.1016/b978-0-323-85029-2.00012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Can equitable Neuropalliative care (NpC) be delivered globally? This chapter surveys existing services and ground realities in different parts of the world. In many countries, universal healthcare (UHC) seems to have been a precondition for the establishment of palliative care (PC). PC has been recognized as a basic human right as a part of UHC. Quality of Death and PC surveys provide an overview of the existing situation. Currently, PC is largely focused on the needs of cancer patients and this is a legacy issue for professionals and systems. Communities however recognize suffering and do not distinguish between medical diagnoses. The development of NpC as a subspecialty of neurology allows neurologists everywhere to become primary palliative care providers for their own patients. It is also necessary to integrate neurology with existing palliative care services. There is much that can be done to improve NpC provision even within the limits that bound every jurisdiction and trial evidence is emerging to inform this practice. This chapter is a survey of the challenges and the potential.
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Affiliation(s)
- Roop Gursahani
- Department of Neurology, P.D. Hinduja National Hospital, Mumbai, India.
| | - Stefan Lorenzl
- Institute of Palliative Care and Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Quach BI, Qureshi D, Talarico R, Hsu AT, Tanuseputro P. Comparison of End-of-Life Care Between Recent Immigrants and Long-standing Residents in Ontario, Canada. JAMA Netw Open 2021; 4:e2132397. [PMID: 34726744 PMCID: PMC8564577 DOI: 10.1001/jamanetworkopen.2021.32397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Recent immigrants face unique cultural and logistical challenges that differ from those of long-standing residents, which may influence the type of care they receive at the end of life. OBJECTIVE To compare places of care among recent immigrants and long-standing residents in Canada in the last 90 days of life. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used linked health administrative data on individuals from Ontario, Canada, who died between January 1, 2013, and December 31, 2016, extracted on February 26, 2020. Individuals were categorized by immigration status: recent immigrants (since 1985) and long-standing residents. Data were analyzed from December 27, 2019, to February 26, 2020. EXPOSURES All decedents who immigrated to Canada between 1985 and 2016 were classified as recent immigrants. Subgroup analyses assessed the association of region of origin. MAIN OUTCOMES AND MEASURES The main outcome was place of care, including institutional and noninstitutional settings, in the last 90 days of life. Descriptive statistics were used to compare characteristics and health service utilization among recent immigrants and long-standing residents. Negative binomial regression models estimated the rate ratios (RR) of using acute care and long-term care in the last 90 days of life. RESULTS A total of 376 617 deceased individuals (median [IQR] age, 80 [68-88] years; 187 439 [49.8%] women and 189 178 [50.2%] men) were identified, among whom 22 423 (6.0%) were recent immigrants; recent immigrants were younger than long-standing residents (median [IQR] age, 76 [60-85] years vs 81 [69-88] years; P < .001), more likely to be living in lower income neighborhoods (12 357 immigrants [55.1%] vs 166 017 long-standing residents [46.9%] in the lower 2 income quintiles; P < .001), and had a higher Charlson Index score (score ≥5, 6294 immigrants [28.1%] vs 74 809 long-standing residents [21.1%]; P < .001). In the last 90 days of life, recent immigrants spent more days in intensive care units than long-standing residents (mean [SD], 2.64 [8.73] days vs 1.47 [5.70] days; P < .001), while long-standing residents spent more days using long-term care than recent immigrants (mean [SD], 19.49 [35.81] days vs 10.45 [27.42] days; P < .001). Being a recent immigrant was associated with a greater likelihood of acute inpatient care use (RR, 1.21; 95% CI, 1.18-1.24) and lower likelihood of long-term care use (RR, 0.66; 95% CI, 0.63-0.70), after adjusting for covariates. CONCLUSIONS AND RELEVANCE These findings suggest that at the end of life, recent immigrants were significantly more likely to receive inpatient and intensive care unit services and die in acute care settings compared with long-standing residents. Further research is needed to examine differences in care preference and disparities for immigrant groups of different origins.
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Affiliation(s)
- Bradley I. Quach
- Faculty of Sciences, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | - Danial Qureshi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| | | | - Amy T. Hsu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
- ICES, Ottawa, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
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8
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Liu X, Liu Z, Zheng R, Li W, Chen Q, Cao W, Li R, Ying W. Exploring the needs and experiences of palliative home care from the perspectives of patients with advanced cancer in China: a qualitative study. Support Care Cancer 2021; 29:4949-4956. [PMID: 33569672 DOI: 10.1007/s00520-021-06037-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/29/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The needs and experiences of palliative home care for patients with advanced cancer have received little research attention. We aimed to explore the needs and experiences of palliative home care among patients with advanced cancer in China. METHODS This qualitative study was conducted using semi-structured interviews with patients with advanced cancer. Participants (n = 15) were recruited from an oncology palliative care unit and a hospice outpatient unit, and were selected using purposive sampling from October 2019 to March 2020. Interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 and developed major themes and subthemes by inductive and constant comparison. RESULTS Five themes were identified: (1) physical need; (2) psychological experience; (3) spiritual need; (4) social need; and (5) information need. Patients need to manage their symptoms (especially cancer pain), prolong life as long as possible, reconstruct their attitudes to adapt to their roles, be socially supported, be respected, maintain spiritual peace, and obtain more information about illness and home care. CONCLUSIONS The current palliative home care services are imperfect, and patients face substantial challenges, including physical symptoms, psychological/spiritual distress, and inadequate social support and information. Our findings may provide evidence and a reference for the development of palliative home care in China.
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Affiliation(s)
- Xiaocheng Liu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Zhili Liu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Ruihua Zheng
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Wenyuan Li
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Qiudi Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Weihua Cao
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Ruina Li
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Wenjuan Ying
- The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
- Nursing Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
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Schwerzmann M, Goossens E, Gallego P, Kovacs AH, Moons P, Swan L, Tobler D, de Stoutz N, Gabriel H, Greutmann M, Roos-Hesselink JW, Sobanski PZ, Thomet C. Recommendations for advance care planning in adults with congenital heart disease: a position paper from the ESC Working Group of Adult Congenital Heart Disease, the Association of Cardiovascular Nursing and Allied Professions (ACNAP), the European Association for Palliative Care (EAPC), and the International Society for Adult Congenital Heart Disease (ISACHD). Eur Heart J 2021; 41:4200-4210. [PMID: 32862229 DOI: 10.1093/eurheartj/ehaa614] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023] Open
Abstract
Survival prospects in adults with congenital heart disease (CHD), although improved in recent decades, still remain below expectations for the general population. Patients and their loved ones benefit from preparation for both unexpected and predictable deaths, sometimes preceded by a prolonged period of declining health. Hence, advance care planning (ACP) is an integral part of comprehensive care for adults with CHD. This position paper summarizes evidence regarding benefits of and patients' preferences for ACP and provides practical advice regarding the implementation of ACP processes within clinical adult CHD practice. We suggest that ACP be delivered as a structured process across different stages, with content dependent upon the anticipated disease progression. We acknowledge potential barriers to initiate ACP discussions and emphasize the importance of a sensitive and situation-specific communication style. Conclusions presented in this article reflect agreed expert opinions and include both patient and provider perspectives.
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Affiliation(s)
- Markus Schwerzmann
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Pastora Gallego
- Department of Cardiology, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n. 41013 Seville, Spain
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN-62 Portland, Oregon, USA
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium.,Institute of Health and Care Science, University of Gothenburg, Arvid Wallgrens Backe, Box 457, 405 30 Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Klipfrontein Road Mowbray, Cape Town 7700, South Africa
| | - Lorna Swan
- Division of Cardiology, Peter Munk Cardiac Centre; Toronto Congenital Cardiac Centre for Adults, University of Toronto, 585 University Avenue; Toronto ON M5G 2N2, Canada
| | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Petersgraben 44031 Basel, Switzerland
| | - Noémi de Stoutz
- European Society of Cardiology Patient Forum Representative, Member of "Cuore Matto" and Global ARCH, Dorfstrasse 64, 8126 Zumikon, Switzerland
| | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus MC, Erasmus University, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Piotr Z Sobanski
- Palliative Care Unit and Competence Center, Department of Internal Medicine, Hospital Schwyz, Waldeggstrasse 10, 6430 Schwyz, Switzerland
| | - Corina Thomet
- Center for Congenital Heart Disease, University Hospital Inselspital, Department of Cardiology, University of Bern, Freiburgstrasse 15, 3010 Bern, Switzerland.,Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, box 7001, 3000 Leuven, Belgium
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10
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Banse C, Owusu-Boakye S, Schade F, Jansky M, Marx G, Nauck F. [Can migration background be a boundary in palliative care at the end of life?]. Dtsch Med Wochenschr 2020; 146:e22-e28. [PMID: 33202430 PMCID: PMC7886499 DOI: 10.1055/a-1263-3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hintergrund
Menschen mit Migrationshintergrund nutzen nach dem Stand der Forschung das palliative Versorgungsangebot wenig. Die möglichen Gründe sind weitgehend unklar. Häufig werden kulturelle Unterschiede geltend gemacht. Eine Untersuchung der Bedürfnisse von krebskranken Patienten mit Migrationshintergrund, ihren Angehörigen und medizinischen und pflegenden Versorgenden in Deutschland bietet einen Überblick über die Versorgungsprobleme.
Methoden
In dem qualitativen Forschungsdesign stehen biografische Erzählungen der Patienten, ihrer Angehörigen und der medizinischen und pflegenden Versorgenden im Vordergrund. Mit der Grounded Theory wurde eine Zeile-für-Zeile-Analyse der Daten durchgeführt, mit der verschiedene Kategorien und Handlungsstrategien im Umgang mit der Krankheit und der Versorgungssituation gefunden werden konnten.
Ergebnisse
Wenn schwerkranke Patienten mit Migrationshintergrund in einer palliativen Versorgungsstruktur ankommen, erleben sie in dieser politische und soziale Abgrenzungen. Migrationsspezifische Einflüsse erschweren deshalb die Bearbeitung der Krankheit und die palliativmedizinische Behandlung und Versorgung am Lebensende. Angehörige und medizinische und pflegende Versorgende erleben die Situation als eine Herausforderung, weil sie den Erwartungen der Patienten nicht entsprechen können und auf Übersetzer und Vermittler angewiesen sind. Viele Probleme werden kulturellen Unterschieden zugerechnet, obwohl die Patienten am Lebensende eher allgemeine Bedürfnisse formulieren.
Schlussfolgerung
Die Palliativversorgung von Menschen mit Migrationshintergrund findet häufig ohne spezifische Kenntnisse der Migrationsbiografie statt. Um den politischen und sozialen Einflüssen gerecht zu werden, bedarf es einer Unterstützung, die die Migrationsbiografie berücksichtigt.
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Affiliation(s)
| | - Sonja Owusu-Boakye
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen.,Department Pflege und Management, Hochschule für Angewandte Wissenschaften Hamburg
| | | | | | - Gabriella Marx
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen.,Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
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11
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Ko E, Fuentes D, Singh-Carlson S, Nedjat-Haiem F. Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study. BMJ Open 2020; 10:e035634. [PMID: 32611740 PMCID: PMC7332198 DOI: 10.1136/bmjopen-2019-035634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. DESIGN This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis. SETTING The HC programme was situated at a local home health agency, located in rural Southern California, USA. PARTICIPANTS Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study. RESULTS Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient's known EOL wishes; (2) FCG-physician EOL communication; (3) the patient's deteriorating health and (4) home as the place for death. CONCLUSIONS HC patients' FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient's EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients' medical status along with information about HC.
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Affiliation(s)
- Eunjeong Ko
- Social Work, San Diego State University, San Diego, California, USA
| | - Dahlia Fuentes
- Social Work, San Diego State University, San Diego, California, USA
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Singh P, King-Shier K, Sinclair S. South Asian patients' perceptions and experiences of compassion in healthcare. ETHNICITY & HEALTH 2020; 25:606-624. [PMID: 32046500 DOI: 10.1080/13557858.2020.1722068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
Background: South Asians are one of the fastest growing ethnic populations in Western countries. Accordingly, providing culturally sensitive healthcare to South Asians is becoming increasingly important. Compassion is a key component of quality healthcare and is central to bridging ethnic and cultural differences between patients and their healthcare providers (HCP).Objective: We aimed to identify and describe the perspectives, experiences, importance, and impact of compassion among South Asian patients.Methods: Straussian grounded theory was used to examine the perspectives of South Asians patients who had recent experience(s) with the Canadian healthcare system. A convenience sample of 19 South Asian participants underwent semi-structured audio-recorded interviews in either English, Hindi, or Punjabi. Transcribed interview data were analyzed using constant comparison.Results: Three categories were generated from the data: (1) South Asians' understandings of compassion, (2) HCPs' cultural sensitivity as an indicator of compassion, and (3) enhancing compassion: importance and patient recommendations for overcoming barriers to compassion. The first category included themes exploring South Asian patients' perspectives of compassion. The second category was divided into themes which examined how delivery and receipt of compassion can be influenced by ethnic and cultural differences between patients and HCPs. The third category consisted of themes highlighting participants' views on the importance of compassion, recommendations for overcoming language and cultural barriers to providing compassion, and the role of compassion in bridging language, culture and ethnic differences between patients and HCPs.Conclusion: Compassion was described as a universal concept that is interpreted through the cultural and ethnic background of the recipient and provider in the way it is perceived, enacted, and received. This information can aid HCP to modulate compassion to South Asian patients and may provide a foundation for future studies on compassion within other cultural groups.
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Affiliation(s)
- Pavneet Singh
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Compassion Research Lab, University of Calgary, Calgary, Canada
| | - Kathryn King-Shier
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Canada
- Compassion Research Lab, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Wei L, Walters J, Guo Q, Fetherston C, O'Connor M. Meaningful and culturally appropriate palliative care for Chinese immigrants with a terminal condition: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2019; 17:2499-2505. [PMID: 31135655 DOI: 10.11124/jbisrir-2017-003867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review aims to identify and synthesize the best qualitative evidence on the experiences of Chinese immigrants receiving palliative care in their country of residence where the culture is predominantly Western, and the experiences of their family carers. INTRODUCTION The recent increase in international immigration has led to challenges in providing culturally appropriate palliative care. Chinese populations have particular beliefs, values and practices surrounding death and filial piety. These differ considerably from those in Western cultures and have significant implications for palliative care service provision. This review will explore the experiences and perceptions of Chinese immigrants and how their cultural beliefs shape their acceptance and decision making related to palliative care. INCLUSION CRITERIA The review will include studies on the experiences of Chinese immigrants over 18 years of age with a terminal medical condition receiving palliative care in outpatient units, hospitals, hospices, specialist palliative care units, homes and community settings in their country of residence where the culture is predominantly Western. METHODS Eligible studies will be studies with qualitative data including designs such as phenomenology, grounded theory, ethnography, narrative research, qualitative description, action research and feminist research published in English and Chinese. CINAHL, PsycINFO, MEDLINE, Scopus and Web of Science Core Collection will be used and grey literature will be searched using ProQuest Dissertations and Theses, OpenGrey and Caresearch. Appraisal of selected studies will be done with the Joanna Briggs Institute Qualitative Assessment and Review tool. Findings will be synthesized through a meta-aggregative approach to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.
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Affiliation(s)
- Li Wei
- School of Health Professions, Murdoch University, Perth, Australia
| | - Jennifer Walters
- School of Health Professions, Murdoch University, Perth, Australia
| | - Qiaohong Guo
- School of Nursing, Capital Medical University, Beijing, People's Republic of China
| | | | - Moira O'Connor
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence
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Jansky M, Owusu-Boakye S, Nauck F. "An odyssey without receiving proper care" - experts' views on palliative care provision for patients with migration background in Germany. BMC Palliat Care 2019; 18:8. [PMID: 30665379 PMCID: PMC6341678 DOI: 10.1186/s12904-019-0392-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Migrants seem to be underrepresented in palliative care in Germany. Access barriers and challenges in care remain unclear. We aimed to provide a comprehensive insight into palliative care for migrants, using expert interviews. Methods Interviews with experts on palliative and general health care for migrants were audiotaped and transcribed. Data analysis followed a qualitative content analysis method for expert interviews proposed by Meuser and Nagel. Results In total, 13 experts from various fields (palliative and hospice care, other care, research and training) were interviewed. Experts identified access barriers on the health care system and the patient level as well as the sociopolitical level. Services don’t address migrants, who may use parallel structures. Patients may distrust the health care system, be oriented towards their home country and expect the family to care for them. In care, poor adaptation and inflexibility of health care services regarding needs of migrant patients because of scarce resources, patients’ preferences which may contradict professionals' values, and communication both on the verbal and nonverbal level were identified as the main challenges. Conflicts between patients, families and professionals are at risk to be interpreted exclusively as cultural conflicts. Palliative care providers should use skilled interpreters instead of family interpreters or unskilled staff members, and focus on training cultural competence. Furthermore, intercultural teams could enhance palliative care provision for migrants. Conclusions Though needs and wishes of migrant patients are often found to be similar to those of non-migrant patients, there are migration-specific aspects that can influence care provision at the end of life. Migration should be regarded as a biographical experience that has a severe and ongoing impact on the life of an individual and their family. Language barriers have to be considered, especially regarding patients' right to informed decision making. The reimbursement of interpreters in health care remains an open question. Electronic supplementary material The online version of this article (10.1186/s12904-019-0392-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany.
| | - Sonja Owusu-Boakye
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
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Cain JM, Denny L. Palliative care in women's cancer care: Global challenges and advances. Int J Gynaecol Obstet 2018; 143 Suppl 2:153-158. [DOI: 10.1002/ijgo.12624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joanna M. Cain
- Department of Obstetrics and Gynecology; University of Massachusetts; Worcester MA USA
| | - Lynette Denny
- Department Obstetrics and Gynecology; University of Cape Town/Groote Schuur Hospital; Cape Town South Africa
- South African Medical Research Council/University of Cape Town Gynaecological Cancer Research Centre (SA MRC/UCT GCRC); Cape Town South Africa
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Singh P, King-Shier K, Sinclair S. The colours and contours of compassion: A systematic review of the perspectives of compassion among ethnically diverse patients and healthcare providers. PLoS One 2018; 13:e0197261. [PMID: 29771933 PMCID: PMC5957374 DOI: 10.1371/journal.pone.0197261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/30/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups. METHODS A systematic search of peer-reviewed research focused on compassionate care in ethnically diverse populations published between 1946 and 2017 was conducted. RESULTS A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients was also identified which included overcoming cultural differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than superimposing a pre-defined, enculturated and researcher-based definition of compassion. CONCLUSIONS This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.
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Affiliation(s)
- Pavneet Singh
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn King-Shier
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Rine CM. Is Social Work Prepared for Diversity in Hospice and Palliative Care? HEALTH & SOCIAL WORK 2018; 43:41-50. [PMID: 29244119 DOI: 10.1093/hsw/hlx048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/09/2017] [Indexed: 06/07/2023]
Abstract
The purpose of this article is to assess current and future trends in hospice and palliative care with the objective of informing culturally appropriate best practice for social work. Concern for the intersectionality of racial, ethnic, social, and other differences in end-of-life (EOL) care is imperative given the ever growing range of diversity characteristics among the increasing aging populations in the United States. A review of literature from the current decade that is pertinent to the profession contributes to the ability of social work to consider evidence and build agreement germane to EOL practice settings. Administrative reports, government data, academic literature, professional standards, and assessment tools contribute to the profession's ability to work toward cultural competence and develop practice strategies for EOL care. The varied roles held by social workers across health care arenas provide a unique opportunity to promote cultural competence and advance best practice on all levels of work.
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Affiliation(s)
- Christine M Rine
- Christine M. Rine, PhD, is assistant professor, Department of Social Work, Edinboro University of Pennsylvania, 235 Scotland Road, Hendricks Hall G-37, Edinboro, PA 16444; e-mail:
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Yarnell CJ, Fu L, Manuel D, Tanuseputro P, Stukel T, Pinto R, Scales DC, Laupacis A, Fowler RA. Association Between Immigrant Status and End-of-Life Care in Ontario, Canada. JAMA 2017; 318:1479-1488. [PMID: 28973088 PMCID: PMC5710367 DOI: 10.1001/jama.2017.14418] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE People who immigrate face unique health literacy, communication, and system navigation challenges, and they may have diverse preferences that influence end-of-life care. OBJECTIVE To examine end-of-life care provided to immigrants to Canada in the last 6 months of their life. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study (April 1, 2004, to March 31, 2015) included 967 013 decedents in Ontario, Canada, using validated linkages between health and immigration databases to identify immigrant (since 1985) and long-standing resident cohorts. EXPOSURES All decedents who immigrated to Canada between 1985 and 2015 were classified as recent immigrants, with subgroup analyses assessing the association of time since immigration, and region of birth, with end-of-life care. MAIN OUTCOMES AND MEASURES Location of death and intensity of care received in the last 6 months of life. Analysis included modified Poisson regression with generalized estimating equations, adjusting for age, sex, socioeconomic position, causes of death, urban and rural residence, and preexisting comorbidities. RESULTS Among 967 013 decedents of whom 47 514 (5%) immigrated since 1985, sex, socioeconomic status, urban (vs rural) residence, and causes of death were similar, while long-standing residents were older than immigrant decedents (median [interquartile range] age, 75 [58-84] vs 80 [68-87] years). Recent immigrant decedents were overall more likely to die in intensive care (15.6% vs 10.0%; difference, 5.6%; 95% CI, 5.2%-5.9%) after adjusting for differences in age, sex, income, geography, and cause of death (relative risk, 1.30; 95% CI, 1.27-1.32). In their last 6 months of life, recent immigrant decedents experienced more intensive care admissions (24.9% vs 19.2%; difference, 5.7%; 95% CI, 5.3%-6.1%), hospital admissions (72.1% vs 68.2%; difference, 3.9%; 95% CI, 3.5%-4.3%), mechanical ventilation (21.5% vs 13.6%; difference, 7.9%; 95% CI, 7.5%-8.3%), dialysis (5.5% vs 3.4%; difference, 2.1%; 95% CI, 1.9%-2.3%), percutaneous feeding tube placement (5.5% vs 3.0%; difference, 2.5%; 95% CI, 2.3%-2.8%), and tracheostomy (2.3% vs 1.1%; difference, 1.2%; 95% CI, 1.1%-1.4%). Relative risk of dying in intensive care for recent immigrants compared with long-standing residents varied according to recent immigrant region of birth from 0.84 (95% CI, 0.74-0.95) among those born in Northern and Western Europe to 1.96 (95% CI, 1.89-2.05) among those born in South Asia. CONCLUSIONS AND RELEVANCE Among decedents in Ontario, Canada, recent immigrants were significantly more likely to receive aggressive care and to die in an intensive care unit compared with other residents. Further research is needed to understand the mechanisms behind this association.
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Affiliation(s)
| | - Longdi Fu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Doug Manuel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | | | - Therese Stukel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Damon C. Scales
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andreas Laupacis
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Programme in Trauma, Emergency, and Critical Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Li Ka Shing Knowledge institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Robert A. Fowler
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Hayes B, Fabri AM, Coperchini M, Parkar R, Austin-Crowe Z. Health and death literacy and cultural diversity: insights from hospital-employed interpreters. BMJ Support Palliat Care 2017; 10:e8. [DOI: 10.1136/bmjspcare-2016-001225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/24/2017] [Accepted: 05/17/2017] [Indexed: 12/15/2022]
Abstract
Objectives001225The aim of this qualitative study is to better understand, through the experiences and insights of hospital interpreters, how people from culturally and linguistic diverse (CALD) communities might respond to advance care planning (ACP) and end-of-life discussions.MethodsHospital interpreters from five Melbourne metropolitan health services were recruited for in-depth semi-structured interviews that explored the question, ‘What can be learnt from hospital interpreters about cultural issues related to ACP and end-of-life decision-making?’ Thirty-nine interpreters, representing 22 language groups, were interviewed. Analysis of the transcribed interviews used qualitative description.ResultsThematic analysis identified three major themes: (1) moral difference; (2) health and death literacy; and (3) diversity within culture.ConclusionA value-based approach to ACP is recommended as a way to capture the person’s individual values and beliefs. Health and death literacy have been identified as areas that may be over-estimated; areas that can be addressed and improved, if recognised. Health and death literacy is a particular area that needs to be assessed and addressed as a pre-requisite to ACP discussions.
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Soto-Perez-de-Celis E, Chavarri-Guerra Y, Pastrana T, Ruiz-Mendoza R, Bukowski A, Goss PE. End-of-Life Care in Latin America. J Glob Oncol 2017; 3:261-270. [PMID: 28717769 PMCID: PMC5493222 DOI: 10.1200/jgo.2016.005579] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inappropriate legislation, lack of comprehensive national palliative care plans, insufficient infrastructure, lack of opportunities for clinical training, unreliable reporting of data, and cultural barriers. This report reviews the current status of end-of-life care in Latin America, focusing on identifying existing deficiencies and providing a framework for improvement.
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Affiliation(s)
- Enrique Soto-Perez-de-Celis
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Yanin Chavarri-Guerra
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Tania Pastrana
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Rossana Ruiz-Mendoza
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Alexandra Bukowski
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Paul E. Goss
- Enrique Soto-Perez-de-Celis and Yanin Chavarri-Guerra, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Enrique Soto-Perez-de-Celis, Yanin Chavarri-Guerra, Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss; The Global Cancer Institute; Rossana Ruiz-Mendoza, Alexandra Bukowski, and Paul E. Goss, Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA; Tania Pastrana, Alexandra Bukowski, and Paul E. Goss, Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany; and Rossana Ruiz-Mendoza, Universidad Peruana Cayetano Heredia, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Paal P, Bükki J. "If I had stayed back home, I would not be alive any more…" - Exploring end-of-life preferences in patients with migration background. PLoS One 2017; 12:e0175314. [PMID: 28384309 PMCID: PMC5383333 DOI: 10.1371/journal.pone.0175314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In patients with life-limiting conditions and a history of migration, a higher risk of not dying at home and limited access to palliative care services has been reported. AIM To explore the views and end-of-life preferences of patients with a migration history in Germany and to identify migration specific themes. DESIGN Two-armed study using Kaufmann's 'understanding interview' ('focused interview') method and grounded theory approach. Thematic content analysis was applied using MaxQDA 12 software. SETTING/PARTICIPANTS Migrant and non-migrant adult patients with far advanced, life-limiting disease receiving palliative care in different specialist level settings (specialist home palliative care, palliative care inpatient unit, inpatient hospice). RESULTS The 37 interviewees (19 native Germans and 18 patients from Europe and the U.S., Israel, Turkey, and Indonesia) expressed eleven themes covering health care- and patient-related issues, of which four emerged to be specific for migrants: worse survival in home country; the perception of an altered identity and 'not belonging'; language skills as prerequisite to survive; and longing for 'home' while being attached to Germany. From these categories, three overarching themes were derived: (1) a limited understanding of the concept of 'palliative care'; (2) the suppression of end of life discussions for its association with suffering and loss of autonomy; and (3) the significance of complex individual migration histories. CONCLUSIONS Based on these findings, the concept of a 'double home' experience is proposed. Barriers to access to palliative care should be minimized for all patients while cultural stereotyping has to be avoided.
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Affiliation(s)
- Piret Paal
- Department of Research and Development, Hospice Care DaSein, Munich, Germany
| | - Johannes Bükki
- Department of Research and Development, Hospice Care DaSein, Munich, Germany
- Institute of Nursing Sciences and Palliative Care, Paracelsus Medical University, Salzburg, Austria
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What Makes a Good Palliative Care Physician? A Qualitative Study about the Patient's Expectations and Needs when Being Admitted to a Palliative Care Unit. PLoS One 2016; 11:e0158830. [PMID: 27389693 PMCID: PMC4936709 DOI: 10.1371/journal.pone.0158830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 06/22/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The aims of the study were to examine a) patients’ knowledge of palliative care, b) patients’ expectations and needs when being admitted to a palliative care unit, and c) patient’s concept of a good palliative care physician. Methods The study was based on a qualitative methodology, comprising 32 semistructured interviews with advanced cancer patients admitted to the palliative care unit of the Medical University of Vienna. Interviews were conducted with 20 patients during the first three days after admission to the unit and after one week, recorded digitally, and transcribed verbatim. Data were analyzed using NVivo 10 software, based on thematic analysis enhanced with grounded theory techniques. Results The results revealed four themes: (1) information about palliative care, (2) supportive care needs, (3) being treated in a palliative care unit, and (4) qualities required of palliative care physicians. The data showed that patients lack information about palliative care, that help in social concerns plays a central role in palliative care, and attentiveness as well as symptom management are important to patients. Patients desire a personal patient-physician relationship. The qualities of a good palliative care physician were honesty, the ability to listen, taking time, being experienced in their field, speaking the patient’s language, being human, and being gentle. Patients experienced relief when being treated in a palliative care unit, perceived their care as an interdisciplinary activity, and felt that their burdensome symptoms were being attended to with emotional care. Negative perceptions included the overtly intense treatment. Conclusions The results of the present study offer an insight into what patients expect from palliative care teams. Being aware of patient’s needs will enable medical teams to improve professional and individualized care.
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Johnstone MJ, Hutchinson AM, Rawson H, Redley B. Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care. Contemp Nurse 2016; 52:269-85. [DOI: 10.1080/10376178.2016.1192953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, Roberts D, Tayler C, Voth J, Stajduhar K. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care 2016; 15:5. [PMID: 26772180 PMCID: PMC4715271 DOI: 10.1186/s12904-016-0076-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
| | - Pat Porterfield
- School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Duncan Dixon
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Kathleen Lounsbury
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Della Roberts
- Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada
| | - Carolyn Tayler
- Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - James Voth
- Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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Roberts LR, Schuh H, Sherzai D, Belliard JC, Montgomery SB. Exploring Experiences and Perceptions of Aging and Cognitive Decline Across Diverse Racial and Ethnic Groups. Gerontol Geriatr Med 2015; 1. [PMID: 26925436 DOI: 10.1177/2333721415596101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore how older adults from three prominent ethnoracial groups experience cognitive decline and aging. METHOD Semistructured key informant interviews (KIIs) and focus groups (FGs) were conducted with caregivers, experts, and older adults. RESULTS (N = 75). Fifteen KIIs regarding cognitive aging issues were conducted among health care professionals and community-based agencies serving older adults. Eight FGs included family caregivers and physicians, and six FGs with Latino, African American, and White older adult community members. Major themes included (a) personal expectations about aging, (b) societal value of older adults, (c) model of care preferred, and (d) community concerns. An overarching theme was a sense of loss associated with aging; however, how this loss was experienced and dealt with varied. DISCUSSION Distinct patterns of concerns and views are important to understand for the development of programs aimed at meeting the needs of diverse older adult community members to improve health outcomes.
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Affiliation(s)
| | - Holly Schuh
- World Health Organization, Geneva, Switzerland
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Park NS, Jang Y, Ko JE, Chiriboga DA. Factors Affecting Willingness to Use Hospice in Racially/Ethnically Diverse Older Men and Women. Am J Hosp Palliat Care 2015; 33:770-6. [PMID: 26071499 DOI: 10.1177/1049909115590976] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Racial/ethnic minorities tend to underutilize hospice services. Guided by Andersen behavioral health model, the purpose of this study was to explore the predictors of the willingness to use hospice services in racially/ethnically diverse older men and women. Data were drawn from the Survey of Older Floridians: 504 non-Hispanic whites, 360 African Americans, 328 Cuban Americans, and 241 non-Cuban Hispanics. In each group, logistic regression models of the willingness to use hospice were estimated. A greater likelihood of willingness was observed among younger non-Hispanic whites and among African Americans with fewer functional disabilities. In non-Cuban Hispanics, English proficiency increased the willingness by 3.1 times. Findings of the study identified group-specific factors contributing to the willingness to use hospice services and hold implications for tailored intervention programs.
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Affiliation(s)
- Nan Sook Park
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Yuri Jang
- School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Jung Eun Ko
- Department of Counseling, Kyung Hee Cyber University, Seoul, South Korea
| | - David A Chiriboga
- Department of Child and Family Studies, University of South Florida, Tampa, FL, USA
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Ozkara San E. Using Clinical Simulation to Enhance Culturally Competent Nursing Care: A Review of the Literature. Clin Simul Nurs 2015. [DOI: 10.1016/j.ecns.2015.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kudla D, Kujur J, Tigga S, Tirkey P, Rai P, Fegg MJ. Meaning in life experience at the end of life: validation of the Hindi version of the Schedule for Meaning in Life Evaluation and a cross-cultural comparison between Indian and German palliative care patients. J Pain Symptom Manage 2015; 49:79-88. [PMID: 24937164 DOI: 10.1016/j.jpainsymman.2014.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/28/2014] [Accepted: 05/16/2014] [Indexed: 12/12/2022]
Abstract
CONTEXT The experience of Meaning in Life (MiL) is a major protective factor against feelings of hopelessness and wishes for hastened death in palliative care (PC) patients. However, most instruments for MiL assessment have been developed only in Western countries so far. Little is known about MiL experience in Asian PC patients. OBJECTIVES This study aimed to provide a Hindi version of the Schedule for Meaning in Life Evaluation (SMiLE), test its feasibility and validity in Indian PC patients, and compare the results with previous studies in Germany. METHODS Indian PC patients in a hospice for the destitute were eligible to participate in this cross-sectional study. In the SMiLE instrument, respondents individually listed MiL-giving areas before rating their satisfaction with and importance of these areas. Overall indices of satisfaction (IoS, range 0-100), weighting (IoW, range 0-100), and weighted satisfaction (IoWS, range 0-100) were calculated. RESULTS A Hindi forward-backward translation of the SMiLE was made. Two hundred fifty-eight Indian PC patients took part in the study (response rate 93.5%). Convergent validity of the SMiLE was found with the World Health Organization Quality of Life-Brief version (r = 0.17; P = 0.008) and the Idler Index of Religiosity (public religiousness: r = 0.25, P < 0.001 and private religiousness: r = 0.29, P < 0.001). Indian PC patients' IoW was 65.8 ± 22.1, IoS 68.6 ± 17.4, and IoWS 70.2 ± 17.0. In multivariate analyses of covariance, they differed significantly from German PC patients only in IoW (IoW: 84.8 ± 11.5, P < 0.001; IoS: 70.2 ± 19.7; IoWS: 72.0 ± 19.4). Compared with Germans, Indians more often listed spirituality (P < 0.001) and social commitment (P < 0.001) and less often social relations (P = 0.008). CONCLUSION Preliminary results indicate good feasibility and validity of the Hindi version of the SMiLE. MiL experience also seems to be a coping resource for Indian PC patients.
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Affiliation(s)
- Dorothea Kudla
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Julius Kujur
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Sumanti Tigga
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Prakash Tirkey
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Punita Rai
- Jesu Ashram, Matigara, Darjeeling District, West Bengal, India
| | - Martin Johannes Fegg
- Department of Palliative Medicine, Ludwig-Maximilians-University, Munich, Germany.
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Busolo D, Woodgate R. Palliative care experiences of adult cancer patients from ethnocultural groups: a qualitative systematic review protocol. ACTA ACUST UNITED AC 2015; 13:99-111. [DOI: 10.11124/jbisrir-2015-1809] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Culturally Congruent End-of-Life Care for Rural Appalachian People and Their Families. J Hosp Palliat Nurs 2014; 16:526-535. [PMID: 25544833 DOI: 10.1097/njh.0000000000000114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nielsen LS, Angus JE, Howell D, Husain A, Gastaldo D. Patient-Centered Care or Cultural Competence. Am J Hosp Palliat Care 2014; 32:372-9. [DOI: 10.1177/1049909114527338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The literature about Chinese attitudes toward death and dying contains frequent references to strong taboos against open discussion about death; consequently, there is an assumption that dying at home is not the preferred option. This focused ethnographic study examined the palliative home care experiences of 4 Chinese immigrants with terminal cancer, their family caregivers, and home care nurses and key informant interviews with 11 health care providers. Three main themes emerged: (1) the many facets of taboo; (2) discursive tensions between patient-centered care and cultural competence; and (3) rethinking language barriers. Thus, training on cultural competence needs to move away from models that portray cultural beliefs as shared, fixed patterns, and take into account the complicated reality of everyday care provision at end of life in the home.
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Affiliation(s)
| | - Jan E. Angus
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Doris Howell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Amna Husain
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Broom A, Kirby E, Good P, Wootton J, Adams J. The troubles of telling: managing communication about the end of life. QUALITATIVE HEALTH RESEARCH 2014; 24:151-162. [PMID: 24469692 DOI: 10.1177/1049732313519709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Communication about palliative care represents one of the most difficult interpersonal aspects of medicine. Delivering the "terminal" diagnosis has traditionally been the focus of research, yet transitions to specialist palliative care are equally critical clinical moments. Here we focus on 20 medical specialists' strategies for engaging patients around referral to specialist palliative care. Our aim was to develop an understanding of the logics that underpin their communication strategies when negotiating this transition. We draw on qualitative interviews to explore their accounts of deciding whether and when to engage in referral discussions; the role of uncertainty and the need for hope in shaping communication; and their perceptions of how patient biographies might shape their approaches to, and communication about, the end of life. On the basis of our analysis, we argue that communication is embedded in social relations of hope, justice, and uncertainty, as well as being shaped by patient biographies.
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Affiliation(s)
- Alex Broom
- 1The University of Queensland, Brisbane, Queensland, Australia
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Dillon PJ, Basu A. HIV/AIDS and minority men who have sex with men: a meta-ethnographic synthesis of qualitative research. HEALTH COMMUNICATION 2014; 29:182-92. [PMID: 23484439 DOI: 10.1080/10410236.2012.732911] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The World Health Organization (2009) estimates that there are as many as 33 million people currently living with HIV/AIDS throughout the world. Studies also reveal that racial disparities significantly influence HIV/AIDS diagnoses within the U.S. men who have sex with men population (MSM). In recent years, the burden of HIV/AIDS has shifted from White MSM to younger men of color, particularly African Americans and Latinos. The disproportionate effect of the HIV/AIDS epidemic in African American and Latino MSM populations requires that scholars and practitioners work diligently to address cultural and structural factors that uniquely influence such populations. The goal of this article is to synthesize qualitative findings that address cultural and structural factors that influence HIV/AIDS risk in African American and Latino MSM populations using a qualitative meta-synthesis procedure. Ultimately, our analysis suggests that "structure-centered" approaches (Dutta & Basu, 2011) are needed to address this health disparity in meaningful ways.
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Aleksandrova-Yankulovska S, ten Have H. Survey of Staff and Family Members of Patients in Bulgarian Hospices on the Concept of “Good Death”. Am J Hosp Palliat Care 2013; 32:226-32. [DOI: 10.1177/1049909113516185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The concept of a “good death” has been intensely discussed over the past decades. The objective of this study is to investigate this concept among staff and patients’ relatives in 29 Bulgarian hospices and 5 palliative care units. Self-administered questionnaires were completed by 190 members of staff and 216 patients’ relatives. Death without pain and suffering and death in one’s sleep were leading concepts in both the groups. Staff preferred death in the presence of relatives, while relatives preferred fast and sudden death. Although we were able to define the common concept of a good death as painless and sudden death in one’s sleep, death is unique phenomenon and good palliative care should be based on communication with patients about their idea of a good death.
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Affiliation(s)
- Silviya Aleksandrova-Yankulovska
- Department of Medical Ethics, Management of Health Care and Information Technology, Faculty of Public Health, Medical University of Pleven, Pleven, Bulgaria
| | - Henk ten Have
- Center for Healthcare Ethics, Duquesne University, Pittsburgh, PA, USA
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35
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Broom A, Good P, Kirby E, Lwin Z. Negotiating palliative care in the context of culturally and linguistically diverse patients. Intern Med J 2013; 43:1043-6. [DOI: 10.1111/imj.12244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A. Broom
- School of Social Science; University of Queensland; Brisbane Queensland Australia
| | - P. Good
- Department of Palliative Care; Mater Health Service; Brisbane Queensland Australia
- St Vincent's Private Hospital Brisbane; Brisbane Queensland Australia
- Mater Research Institute; University of Queensland; Brisbane Queensland Australia
| | - E. Kirby
- School of Social Science; University of Queensland; Brisbane Queensland Australia
| | - Z. Lwin
- Department of Medical Oncology; Mater Health Services; Brisbane Queensland Australia
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Integration of Latino/a cultural values into palliative health care: A culture centered model. Palliat Support Care 2013; 12:149-57. [DOI: 10.1017/s147895151300028x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Culture helps us grapple with, understand, and navigate the dying process. Although often overlooked, cultural values play a critical and influential role in palliative care. The purpose of the present study was two-fold: one, to review whether Latino/a cultural values have been integrated into the palliative care literature for Latinos/as; two, identify publications that provide recommendations on how palliative care providers can integrate Latino/a cultural values into the end-of-life care.Method:A comprehensive systematic review on the area of Latino/a cultural values in palliative care was conducted via an electronic literature search of publications between 1930–2013. Five articles were identified for reviewing, discussing, or mentioning Latino/a cultural values and palliative care.Results:Only one article specifically addressed Latino/a cultural values in palliative care. The four remaining articles discuss or mention cultural values; however, the cultural values were not the main focus of each article's thesis.Significance of results:The results of the current study highlight the lack of literature specifically addressing the importance of integrating Latino/a cultural values into the delivery of palliative care. As a result, this article introduces the Culture-Centered Palliative Care Model (CCPC). The article defines five key traditional Latino/a cultural values (i.e., familismo, personalismo, respeto, confianza, and dignidad), discusses the influence of each value on palliative health care, and ends with practical recommendations for service providers. Special attention is given to the stages of acculturation and ethnic identity.
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Slocum-Gori S, Hemsworth D, Chan WWY, Carson A, Kazanjian A. Understanding Compassion Satisfaction, Compassion Fatigue and Burnout: a survey of the hospice palliative care workforce. Palliat Med 2013; 27:172-8. [PMID: 22179596 DOI: 10.1177/0269216311431311] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the increasingly crucial role of the healthcare workforce and volunteers working in hospice and palliative care (HPC), very little is known about factors that promote or limit the positive outcomes associated with practicing compassion. AIM The purpose of this study was to: 1) understand the complex relationships among Compassion Satisfaction, Compassion Fatigue and Burnout within the hospice and palliative care workforce and 2) explore how key practice characteristics - practice status, professional affiliation, and principal institution - interact with the measured constructs of Compassion Satisfaction, Compassion Fatigue and Burnout. DESIGN Self-reported measures of Compassion Satisfaction, Compassion Fatigue and Burnout, using validated scales, as well as questions to describe socio-demographic profiles and key practice characteristics were obtained. SETTING/PARTICIPANTS A national survey of HPC workers, comprising clinical, administrative, allied health workers and volunteers, was completed. Respondents from hospital, community-based and care homes informed the results of our study (n = 630). RESULTS Our results indicate a significant negative correlation between Compassion Satisfaction and Burnout (r = -0.531, p < 0.001) and between Compassion Satisfaction and Compassion Fatigue (r = -0.208, p < 0.001), and a significant positive correlation between Burnout and Compassion Fatigue (r = 0.532, p < 0.001). Variations in self-reported levels of the above constructs were noted by key practice characteristics. Levels of all three constructs are significantly, but differentially, affected by type of service provided, principal institution, practice status and professional affiliation. Results indicate that health care systems could increase the prevalence of Compassion Satisfaction through both policy and institutional level programs to support HPC professionals in their jurisdictions.
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Affiliation(s)
- Suzanne Slocum-Gori
- University of British Columbia, School of Population and Public Health, Faculty of Medicine, Vancouver, Canada
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Concepts and definitions for "supportive care," "best supportive care," "palliative care," and "hospice care" in the published literature, dictionaries, and textbooks. Support Care Cancer 2012; 21:659-85. [PMID: 22936493 DOI: 10.1007/s00520-012-1564-y] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 07/31/2012] [Indexed: 12/27/2022]
Abstract
PURPOSE Commonly used terms such as "supportive care," "best supportive care," "palliative care," and "hospice care" were rarely and inconsistently defined in the palliative oncology literature. We conducted a systematic review of the literature to further identify concepts and definitions for these terms. METHODS We searched MEDLINE, PsycInfo, EMBASE, and CINAHL for published peer-reviewed articles from 1948 to 2011 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. Dictionaries/textbooks were also searched. RESULTS Nine of 32 "SC/BSC," 25 of 182 "PC," and 12 of 42 "HC" articles focused on providing a conceptual framework/definition. Common concepts for all three terms were symptom control and quality-of-life for patients with life-limiting illness. "SC" focused more on patients on active treatment compared to other categories (9/9 vs. 8/37) and less often involved interdisciplinary care (4/9 vs. 31/37). In contrast, "HC" focused more on volunteers (6/12 vs. 6/34), bereavement care (9/12 vs. 7/34), and community care (9/12 vs. 6/34). Both "PC" and "SC/BSC" were applicable earlier in the disease trajectory (16/34 vs. 0/9). We found 13, 24, and 17 different definitions for "SC/BSC," "PC," and "HC," respectively. "SC/BSC" was the most variably defined, ranging from symptom management during cancer therapy to survivorship care. Dictionaries/textbooks showed similar findings. CONCLUSION We identified defining concepts for "SC/BSC," "PC," and "HC" and developed a preliminary conceptual framework unifying these terms along the continuum of care to help build consensus toward standardized definitions.
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Kwon SH. [Development and validation of the hospice palliative care performance scale]. J Korean Acad Nurs 2011; 41:374-81. [PMID: 21804346 DOI: 10.4040/jkan.2011.41.3.374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE The purpose of this study was to develop and validate a hospice-palliative care performance measure which would cover more than just physical symptoms or quality of life. METHODS Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice-palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice-palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency. RESULTS Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's alpha of the subscales ranged from .73 to .79. CONCLUSION The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice-palliative care for terminal cancer patients in practice and research.
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Affiliation(s)
- So-Hi Kwon
- College of Nursing, Kyungpook National University, The Research Institute of Nursing Science, Daegu, Korea.
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40
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Desai AK, Grossberg GT. Palliative and end-of-life care in psychogeriatric patients. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/ahe.11.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A rapidly growing number of elderly persons and their families are burdened by one or more terminal illnesses in the later years of their life. How best to support their quality of life is a major challenge for healthcare teams. Palliative and end-of-life (PEOL) care is well positioned to respond to this challenge. While the evidence of PEOL is just beginning, much of the suffering can be relieved by what is already known. PEOL care for the elderly needs to go beyond the focus on the patient and should rest on a broad understanding of the nature of suffering that includes family and professional caregivers in that experience of suffering. The dissemination of PEOL care principles should be a public health priority. This article aims to improve understanding of appropriate PEOL care in the elderly and discuss future perspectives.
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Affiliation(s)
- Abhilash K Desai
- Department of Neurology & Psychiatry, Saint Louis University School of Medicine, 1438 S. Grand Blvd, St Louis, MO 63104, USA
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Kato Y, Akiyama M, Itoh F, Ida H. A Study Investigating the Need and Impact of Pediatric Palliative Care Education on Undergraduate Medical Students in Japan. J Palliat Med 2011; 14:560-2. [DOI: 10.1089/jpm.2010.0475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yoko Kato
- Department of Pediatrics, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Masaharu Akiyama
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Fumiyuki Itoh
- Department of Pediatrics, Daisan Hospital, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
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