1
|
Assaf G, Jawhar S, Wahab K, El Hachem R, Kaur T, Tanielian M, Feghali L, Al Hazzouri AZ, Elbejjani M. Awareness and attitudes towards advance care planning in primary care: role of demographic, socioeconomic and religiosity factors in a cross-sectional Lebanese study. BMJ Open 2021; 11:e052170. [PMID: 34711599 PMCID: PMC8557299 DOI: 10.1136/bmjopen-2021-052170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess awareness and attitudes towards engaging in advance care planning (ACP) and their relationship with demographic, socioeconomic and religiosity factors among Lebanese middle-aged to older-aged adults in primary care. DESIGN A cross-sectional survey study. SETTING Tertiary referral hospital in Beirut, Lebanon. PARTICIPANTS A total of 215 middle-aged to older-aged adults. RESULTS Out of 215 participants, 18.6% of participants knew about ACP; 94% favoured truth-telling; 87.4% favoured healthcare autonomy; 77.2% favoured documenting their own health values and preferences; and 29.3% were willing to undergo life-prolonging interventions. Among participants who were aware of ACP, 67.5% preferred ACP documentation and 85% had negative attitudes towards life-sustaining interventions. Women were more aware about ACP than men. Those who were willing to undergo life-prolonging interventions were found to be men and had higher religiosity scores. CONCLUSION Large deficit in ACP awareness was evident despite the high preference for healthcare autonomy. Medical and public health efforts should strive to enhance patients' ACP awareness and engagement in ACP while considering factors relevant to gender, culture and religiosity.
Collapse
Affiliation(s)
- Georges Assaf
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sarah Jawhar
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kamal Wahab
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rita El Hachem
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tanjeev Kaur
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Tanielian
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lea Feghali
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adina Zeki Al Hazzouri
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
2
|
Gustafson C, Lazenby M. Assessing the Unique Experiences and Needs of Muslim Oncology Patients Receiving Palliative and End-of-Life Care: An Integrative Review. J Palliat Care 2018; 34:52-61. [PMID: 30231835 DOI: 10.1177/0825859718800496] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this review was to detail the experiences of Muslim oncology patients receiving palliative and end-of-life care and identify where gaps in the providing of culturally aware care occur. We also sought to examine ways in which providers could be better educated on the needs of Muslim patients at the end-of-life and identify barriers Muslims faced when being treated with hospice and palliative care models developed for non-Muslim populations. We conducted a search in April 2018 in the National Library of Medicine and CINAHL databases using the search terms "palliative care," "Muslim," and "cancer." Included were articles with focuses on adult Muslims with palliative and end-of-life care experiences. We then followed the PRISMA guidelines for an integrative review and used a data extraction matrix to identify 20 papers that met the inclusion criteria of the review. We identified four major themes patient experiences, patient care delivery suggestions, Muslim provider experiences, and definitions of death, present in all 20 papers of the review. Each of the included papers was categorized based on the dominant theme in the paper. This review ultimately found that the care provided to Muslim patients is subpar for the standard of culturally competent care and that the needs of Muslim patients at the end-of-life, as well as the needs of their families, are not being met. Moving forward further research on this topic is needed with a particular focus on examining the experiences of terminally ill Muslim patients receiving treatment in non-Muslim majority settings.
Collapse
|
3
|
Ding M, Johnston ANB, Mohammed OA, Luong K, Massey D. Do consumers who identify as Muslim experience culturally safe care (CSC) in the Emergency Department (ED)? A scoping review. Australas Emerg Care 2018; 21:93-98. [PMID: 30998884 DOI: 10.1016/j.auec.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/03/2018] [Accepted: 08/05/2018] [Indexed: 11/28/2022]
Abstract
Lack of awareness about cultural and religious values and beliefs of patients presenting to Emergency Departments (ED) can compromise patient care and safety. Muslim Australians represent the fastest growing religious demographic group, with over a 77% growth in the last decade. The changing face of the Australian population requires that Australian health care carefully consider the dominant Western cultural paradigm currently influencing health care delivery. This predominance is particularly critical in the ED, as it is a common gateway into health care services. This scoping review explores the evidence of key components and impacts of culturally safe care (CSC) in the ED for staff and care consumers who identify as Muslim. A systematic search using electronic (five databases) and heading searching methods for primary research was undertaken; followed by a rigorous screening and quality appraisal process. Included articles were assessed for similarities and differences, and the subsequent content was grouped, synthesized and tested for clinical salience using the six stages of the Arksey and O'Malley methodological framework. The Mixed Method Assessment Tool was used to appraise the quality of included literature. Three studies were included in the analysis. Religious beliefs and practices are common among the individuals who identify as Muslim. Such beliefs and practices could influence patients' understanding of their conditions, their acceptance of care delivery, their processes of decision-making, and their commitment to treatment regimens and coping strategies. These ideals could also impact on a patient's care seeking behaviors and on family and community acceptance of care delivery. There is a serious lack of evidence around the delivery of culturally safe care in the ED locally and internationally. While many EDs may have procedure documents or staff care guidelines, it is unclear as to how these guides were derived, as there is minimal published evidence exploring any issues around provision of CSC to Muslim ED care consumers.
Collapse
Affiliation(s)
- Mingshuang Ding
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane 4000, Queensland, Australia; Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Coopers Plains 4108, Queensland, Australia
| | - Amy N B Johnston
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba 4102, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Woolloongabba 4102, Queensland, Australia.
| | - Omer A Mohammed
- Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Coopers Plains 4108, Queensland, Australia
| | - Kathy Luong
- Faculty of Medicine, The University of Queensland, St. Lucia, Queensland, Australia
| | - Debbie Massey
- School of Nursing, Midwifery and Paramedicine, Faculty of Health, University of Sunshine Coast, Maroochydore DC 4558, Queensland, Australia
| |
Collapse
|
4
|
Zaman S, Inbadas H, Whitelaw A, Clark D. Common or multiple futures for end of life care around the world? Ideas from the 'waiting room of history'. Soc Sci Med 2017; 172:72-79. [PMID: 27894008 PMCID: PMC5224187 DOI: 10.1016/j.socscimed.2016.11.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Around the world there is growing interest in the manner in which care is delivered to people at the end of life. However, there is little unanimity on what constitutes a 'good death' and the appropriate societal responses to the issue of delivering culturally relevant and sustainable forms of end of life care in different settings are not subjects of broad agreement. In this critical conceptual paper we focus on the emerging narratives of global palliative care and offer an assessment of their implications. We relate this to calls to improve end of life care across jurisdictions and settings, attempts to map and grade the development of palliative care provision, and to the emergence of a widely recognised global 'quality of death index'. We consider an alternative approach to framing this debate, drawn from a subaltern and post-colonial studies perspective and suggest that adopting a truly global perspective will require acceptance of the plurality of past and present local problems and issues relating to end of life care, as well as the plural possibilities of how they might be overcome. In that context, we would not aim to universalise or privilege one particular global future for end of life care. Instead of homogenising end of life interventions, we seek to be open to multiple futures for the care of the dying.
Collapse
Affiliation(s)
- Shahaduz Zaman
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - Hamilton Inbadas
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - Alexander Whitelaw
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| | - David Clark
- School of Interdisciplinary Studies, The University of Glasgow, Crichton University Campus, Dumfries, DG1 4ZL, Scotland, UK.
| |
Collapse
|
5
|
Noureddine S, Avedissian T, Isma'eel H, El Sayed MJ. Assessment of cardiopulmonary resuscitation practices in emergency departments for out-of-hospital cardiac arrest victims in Lebanon. J Emerg Trauma Shock 2016; 9:115-21. [PMID: 27512333 PMCID: PMC4960778 DOI: 10.4103/0974-2700.185275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The survival rate of out-of-hospital cardiac arrest (OHCA) victims in Lebanon is low. A national policy on resuscitation practice is lacking. This survey explored the practices of emergency physicians related to the resuscitation of OHCA victims in Lebanon. METHODS A sample of 705 physicians working in emergency departments (EDs) was recruited and surveyed using the LimeSurvey software (Carsten Schmitz, Germany). Seventy-five participants responded, yielding 10.64% response rate. RESULTS The most important factors in the participants' decision to initiate or continue resuscitation were presence of pulse on arrival (93.2%), underlying cardiac rhythm (93.1%), the physician's ethical duty to resuscitate (93.2%), transport time to the ED (89%), and down time (84.9%). The participants were optimistic regarding the survival of OHCA victims (58.1% reporting > 10% survival) and reported frequent resuscitation attempts in medically futile situations. The most frequently reported challenges during resuscitation decisions were related to pressure or presence of victim's family (38.8%) and lack of policy (30%). CONCLUSION In our setting, physicians often rely on well-established criteria for initiating/continuing resuscitation; however, their decisions are also influenced by cultural factors such as victim's family wishes. The findings support the need for a national policy on resuscitation of OHCA victims.
Collapse
Affiliation(s)
- Samar Noureddine
- Department of Nursing, Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Tamar Avedissian
- Department of Nursing, Hariri School of Nursing, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Hussain Isma'eel
- Division of Cardiology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| | - Mazen J El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
| |
Collapse
|
6
|
Dumit NY, Abboud S, Massouh A, Magilvy JK. Role of the Lebanese family caregivers in cardiac self-care: a collective approach. J Clin Nurs 2015; 24:3318-26. [PMID: 26249817 DOI: 10.1111/jocn.12949] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2015] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES The purpose of this study was to explore perceptions of cardiac self-care among Lebanese family caregivers of cardiac patients. The specific aims were to describe the cultural context of cardiac care-giving in Lebanon and to explore the roles of family caregivers in enhancing self-care practices in patients with cardiac diseases. BACKGROUND The role of family caregivers in Lebanon, a country in the Middle East, is assumed to extend beyond care-giving to making decisions on behalf of the patient and assuming responsibility for patient care. To date, there has been no study done to empirically validate this impression. DESIGN The design of the study is qualitative descriptive that used semi-structured individual interviews with family caregivers of Lebanese cardiac patients. METHOD Thirteen family caregivers of cardiac patients were recruited from a referral medical centre in Lebanon. The participants were designated by their patients and interviewed in a place of their choice. RESULTS One overarching and three themes emerged from data analysis describing roles of family care givers in cardiac self-care. The overarching theme was: Family caregivers of Lebanese cardiac patients were unfamiliar with the term, concept and meaning of Self-Care. The moral and emotional duty to care for the family member stemmed from obligation and responsibility towards patients (theme I). Interdependent care (theme II) between cardiac patients and their families emerged as a significant cultural role. Family members play multiple supportive roles in care-giving namely emotional, informational and instrumental role (theme III). CONCLUSION In this study, family caregiver role is shown to be based in the sense of obligation and duty towards the sick family member who collectively provide different types of supportive care. RELEVANCE TO CLINICAL PRACTICE Nurses have to give significant importance to the family caregiver role as an integral part of any culturally sensitive patient/family intervention.
Collapse
Affiliation(s)
- Nuhad Y Dumit
- School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Sarah Abboud
- Centers for Global Women's Health and Health Equity Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Angela Massouh
- School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Joan K Magilvy
- University of Colorado Denver College of Nursing, Aurora, CO, USA
| |
Collapse
|
7
|
Dumit NY, Magilvy JK, Afifi R. The Cultural Meaning of Cardiac Illness and Self-Care Among Lebanese Patients With Coronary Artery Disease. J Transcult Nurs 2015; 27:385-91. [PMID: 25693831 DOI: 10.1177/1043659615573080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cardiac disease is the leading cause of death in Lebanon, accounting for 22% to 26% of total deaths in the country. A thorough understanding of perceptions of cardiac illness and related self-care management is critical to the development of secondary prevention programs that are specific to the Lebanese culture. PURPOSE To explore the cultural perceptions of cardiac illness and the associated meaning of self-care among Lebanese patients. DESIGN Using a qualitative descriptive method, semistructured interviews were conducted with a purposive sample of 15 Lebanese cardiac patients recruited from a medical center in Beirut, Lebanon. FINDINGS The qualitative descriptive analysis yielded one overarching and two other themes describing perceptions of cardiac illness and self-care within the Lebanese cultural context. The overarching cultural theme was, "Lebanese cardiac patients were unfamiliar with the term concept and meaning of self-care." Lebanese cardiac patients thanked God and accepted their fate (Theme I). The participants considered their cardiac incident a life or death warning (Theme II). IMPLICATIONS FOR PRACTICE Health care providers need to consider patients' cultural perception of illness while planning and evaluating cardiac self-care programs.
Collapse
Affiliation(s)
| | | | - Rima Afifi
- University of Colorado Denver College of Nursing, Aurora, CO, USA
| |
Collapse
|
8
|
Johnstone MJ, Kanitsaki O. Ethics and Advance Care Planning in a Culturally Diverse Society. J Transcult Nurs 2009; 20:405-16. [DOI: 10.1177/1043659609340803] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.
Collapse
|