Perceptions of palliative care in a lower middle-income Muslim country: A qualitative study of health care professionals, bereaved families and communities

The meaning of culture in nursing at the end of life - an interview study with nurses in specialized palliative care

BACKGROUND

The countries of the world are becoming increasingly multicultural and diverse, both as a result of growing migration, of people fleeing countries at war but also due to increased mobility related to labour immigration. Culture is a broad concept where the definitions focus on learned and shared values, traditions, and beliefs of a group of individuals. People's culture affects health and perceptions of illness as well as treatment, symptoms, and care. Moreover, people who are at the end of life, live and exist within all levels and contexts of care. Specialized palliative care requires that the nurse has sufficient knowledge and skills to be responsible for meeting the patient's nursing needs also on a cultural level, regardless of cultural affiliation. The aim of the study was to highlight nurses' experiences of the meaning of culture when caring for patients at the end of life in specialized palliative care.

METHODS

The study was conducted with a qualitative design and inductive approach. Semi-structured interviews were conducted with twelve nurses in western Sweden. Data were analysed using qualitative content analysis.

RESULTS

The nurses had an awareness of culture as a phenomenon and how it affected palliative care at the end of life. The results showed two categories, Awareness of the impact of culture on nursing and Culture's impact and influence on the nurse's mindset and approach, consisting of seven subcategories that highlight the nurse's experience. It emerged that there are differences between cultures regarding notions of dying and death, who should be informed, and treatments. There were also challenges and emotions that arose when cultural preferences differed among everyone involved. A person-centred approach allowed for recognition of the dying person's culture, to meet diverse cultural needs and wishes.

CONCLUSION

Providing culturally competent care is a major challenge. There are often no routines or methods prescribed for how nurses should relate to and handle the diversity of cultural notions that may differ from the values and cornerstones of palliative care. Having a person-centred approach as strategy can help to better manage the situation and provide equitable care on terms that respect cultural diversity.

Understanding Family Members in the Palliative Phases of Their Loved Ones: A Qualitative Study

Because of aging and rising rates of chronic diseases, the demand for palliative care services is increasing worldwide, and patients need family members to care for them throughout the palliative care process. This study aimed to investigate the experiences of the relatives of palliative care patients during hospitalization. This was a qualitative study conducted with 15 family members. A topic guide was used to conduct semistructured face-to-face interviews. Content analysis was used to analyze the textual data. As a result of the analysis, 3 main themes, 6 categories, and 24 subcategories emerged. The main themes were "reactions to the admission," "feeling obligated to care," and "coping processes." The interviews revealed that most participants had misconceptions and a lack of knowledge about palliative care. Almost all of the family members expressed that they experienced various emotions during this process and had trouble coping. The significant finding of our study is that culture and religious beliefs have a considerable influence on caregiving. A limited number of studies in the literature provide detailed insight into the state of patient relatives. Therefore, this study is critical in guiding palliative care professionals in understanding the requirements of this vulnerable group.

How do cultural factors influence the provision of end-of-life care? A narrative review

BACKGROUND

Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life.

OBJECTIVE

Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life?

METHODS

A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included.

RESULTS

A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism).

CONCLUSIONS

These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.

Perspectives of Indonesian Muslim patients with advanced lung cancer on good death: A qualitative study

PURPOSE

Lung cancer is the leading cause of cancer-related death. Patients with advanced lung cancer may experience burdensome distress at the end of life. The concept of good death has been shown to be complex, and continues to be expanded by gaining a better understanding of the cultural views of different populations. This study aimed to explore the perspective of Indonesian Muslims patients with advanced cancer on the concept of good death.

METHOD

A qualitative design comprising in-depth interviews was employed. Seven male and 3 female Muslim patients between ages 36 and 68 and diagnosed with advanced lung cancer were recruited from a teaching hospital in Central Java, Indonesia.

RESULTS

Content analysis of the interviews revealed five themes: dying without physical discomfort, dying in religious ways and in a desirable place, dying without emotional discomfort, receiving help and support, and having a good relationship with medical staff.

CONCLUSIONS

Indonesian Muslim patient with advanced lung cancer have unique perspectives on good death, especially based on the themes of religious ways of dying and support from family. Health care providers should be aware that good death is not an individual concern and should thus adopt highly sensitive observation skills to assess the physical and emotional state of patients. These providers must also understand their patients' preferences and respect their needs, regardless of their own beliefs.

Student Nurses' Perception of Good Death and Religious Coping Styles

This research aims to examine the perception of the good death and religious coping styles of student nurses. The research is a correlational descriptive study. The research was conducted with 358 nursing students at a state university in the east of Turkey. It was found in the study that students had a good perception of death (58.83 ± 6.12) and mostly used positive religious coping styles (positive/24.55 ± 3.71, negative/13.31 ± 4.21). As a result of the correlation analysis, a weakly significant positive relationship was determined between good death perception and positive religious coping (p < .001).This study observed that students' perceptions of good death increased along with their positive religious coping styles.

Women's experiences of advanced breast cancer in a resource-limited Arab context: A Stakian multi-case study

OBJECTIVE

Breast cancer is the most common cancer for women, globally. Women are more likely to present with more advanced cancer and palliative care needs in low-resource contexts. There is limited research on Arab, Muslim and African women's experiences of advanced breast cancer. The aim of this study was to explore and understand the experiences of advanced breast cancer in the Islamic Republic of Mauritania.

METHODS

Using a constructivist Stakian multi-case study approach, eight cases were constructed with women with advanced breast cancer (n = 8), family members (n = 10) and health professionals (n = 9). Data were collected longitudinally (up to nine months per case) and included semi-structured interviews and audio-journals. Data from 58 interviews and 31 journal entries were thematically analysed.

RESULTS

Three key themes were identified: 1. Destiny: Maure women appreciate that Allah is all powerful and maintains control over their destinies and their breast cancer. 2. Patience & Acceptance: a fear of causing offence to Allah influences how women express their experiences of breast cancer and its treatments. 3. Journeying in search of a cure: Maure women have limitled access to information around their cancer and its treatments. Women use their own observations and interpretations to understand their breast cancer and guide their pursuit of treatment and a cure.

CONCLUSION

Maure women feel reassured that life and cure remain possible because of Allah's sustenance; but are aware that the gift of life is fragile. They experience restricted power over how they express negative experiences, access to information, and healthcare decisions.

Quantifying the Language Barrier-A Total Survey of Parents' Spoken Languages and Local Language Skills as Perceived by Different Professions in Pediatric Palliative Care

To date, there are no specific figures on the language-related characteristics of families receiving pediatric palliative care. This study aims to gain insights into the languages spoken by parents, their local language skills and the consistency of professional assessments on these aspects. Using an adapted version of the “Common European Framework of Reference for Languages”, the languages and local language skills of parents whose children were admitted to an inpatient pediatric palliative care facility (N = 114) were assessed by (a) medical staff and (b) psychosocial staff. Nearly half of the families did not speak the local language as their mother tongue. The most frequently spoken language was Turkish. Overall, the medical staff attributed better language skills to parents than the psychosocial staff did. According to them, only 27.0% of mothers and 38.5% of fathers spoke the local language at a high level while 37.8% of mothers and 34.6% of fathers had no or rudimentary language skills. The results provide important information on which languages pediatric palliative care practitioners must be prepared for. They sensitize to the fact that even within an institution there can be discrepancies between the language assessments of different professions.