Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals

Frey, Rosemary; Raphael, Deborah; Bellamy, Gary; Gott, Merryn

doi:10.1111/hsc.12081

Cited by 32 publications

(39 citation statements)

References 44 publications

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“…Some of the expected challenges that this study brings attention to (i.e. communication barriers, ‘unusual’ emotional expressions or pain, ‘different’ families and relatives, as well as lack of knowledge), and the consequences of such challenges in terms of staff feeling uncertainty and stress are supported by previous research [5–8] [10] [19]. One of the identified challenges entailed the notion that these patients’ and their families lack knowledge on an array of issues.…”

Section: Discussionsupporting

confidence: 69%

Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

2016

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ObjectiveThe academic debate on cross-cultural interaction within the context of end-of-life care takes for granted that this interaction is challenging. However, few empirical studies have actually focused on what health care professionals think about this interaction. This study aimed to explore health care professionals’ understandings of cross-cultural interaction during end-of-life care.MethodsSixty end-of-life care professionals were recruited from eleven care units in Sweden to take part in focus group interviews. These interviews were analyzed using qualitative content analysis.ResultsThe health care professionals interviewed talked about cross-cultural interaction in end-of-life care as interaction that brings about uncertainty, stress and frustration even though they had limited experience of this type of interaction. The focus group discussions brought attention to four specific challenges that they expected to meet when they care for patients with migrant backgrounds since they took for granted that they would have an ethno-cultural background that is different to their own. These challenges had to do with communication barriers, ‘unusual’ emotional and pain expressions, the expectation that these patients’ families would be ‘different’ and the anticipation that these patients and their families lack knowledge. At the core of the challenges in question is the idea that cross-cultural interaction means meeting “the unknown”. In addition, the end-of-life care professionals interviewed talked about patients whose backgrounds they did not share in homogenizing terms. It is against this backdrop that they worried about their ability to provide end-of-life care that is individualized enough to meet the needs of these patients.ConclusionsThe study suggests that end-of-life care professionals who regard cross-cultural interaction in this manner could face actual challenges when caring for patients whose backgrounds they regard as “the unknown” since they anticipate a variety of challenges and do not seem confident enough that they can provide good quality care when cross-cultural interaction is at stake.

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Section: Discussionsupporting

confidence: 69%

Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

2016

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“…For instance, the study by Ryan et al (2012) reported more than nearly two-thirds of nurses being knowledgeable about AD [17], while the study by Jezewski et al reported 70% of nurses to have general awareness of AD and 53% of them had legal knowledge on AD [18, 19]. …”

Section: Discussionmentioning

confidence: 99%

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Peičius

Blaževičienė

2017

BMC Med Ethics

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BackgroundThis paper joins the debate over changes in the role of health professionals when applying advance directives to manage the decision-making process at the end of life care. Issues in relation to advance directives occur in clinical units in Lithuania; however, it remains one of the few countries in the European Union (EU) where the discussion on advance directives is not included in the health-care policy-making agenda. To encourage the discussion of advance directives, a study was designed to examine health professionals’ understanding and preferences related to advance directives. In addition, the study sought to explore the views of health care professionals of the application of Advance Directives (AD) in clinical practice in Lithuania.MethodsA cross-sectional survey was conducted by interviewing 478 health professionals based at major health care centers in Kaunas district, Lithuania. The design of the study included the use of a questionnaire developed for this study and validated by a pilot study. The collected data were analyzed using standard descriptive statistical methods.ResultsThe analysis of knowledge about AD revealed some statistically significant differences when comparing the respondents’ profession and gender. The analysis also indicated key emerging themes among respondents including tranquility of mind, the longest possible life expectancy and freedom of choice.Further, the study findings revealed that more than half of the study participants preferred to express their will while alive by using advance directives.ConclusionsThe study findings revealed a low level of knowledge on advance directives among health professionals. Most health professionals agreed that AD’s improved end-of-life decision making while the majority of physicians appreciated AD as the best tool for sharing responsibilities in clinical practice in Lithuania. More physicians than nurses preferred the presence of advance directives to support their decision making in end-of-life situations.

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“…By contrast, in collectivist cultures, relationships within the extended family are more highly valued than personal autonomy (Frey et al, 2014). But even if patients operate within the cultural context of individual informed choice, the EOL choice agenda can still be problematic, as outlined in the following sections.…”

Section: Analysis 1) Choicementioning

confidence: 99%

Choice and compassion at the end of life: A critical analysis of recent English policy discourse

Borgstrom

Walter

2015

Social Science & Medicine

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End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done.Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity.Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries. KeywordsEngland, end of life care, choice, compassion, discourse, old age, relational ethics, governmentality 2 Research Highlights• The 'choice' agenda arises out of (cancer) palliative care.• The 'compassion' agenda arises out of elder care scandals.• Compassion signifies care as a relationship rather than a commodity.• Compassion can be undermined by an overemphasis on autonomous individuals.

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Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals

Cited by 32 publications

References 44 publications

Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

Health Care Professionals’ Understandings of Cross-Cultural Interaction in End-of-Life Care: A Focus Group Study

Are advance directives helpful for good end of life decision making: a cross sectional survey of health professionals

Choice and compassion at the end of life: A critical analysis of recent English policy discourse

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