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Olazagasti C, Florez N. Going Back Home: Understanding Physician Migration to the United States. JCO Glob Oncol 2023; 9:e2300332. [PMID: 37944086 PMCID: PMC10645410 DOI: 10.1200/go.23.00332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
In 2021, US foreign-born population reached a high of 14.2% of the total US population. Up to 28% of US working immigrants are physicians. The decision to leave one's home country, though, is rarely an easy one to make and is often riddled with cultural and emotional challenges.
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Affiliation(s)
- Coral Olazagasti
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Narjust Florez
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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2
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Padela AI, Azam L, Murrar S, Baqai B. Muslim American physicians' experiences with, and views on, religious discrimination and accommodation in academic medicine. Health Serv Res 2023; 58:733-743. [PMID: 36815275 PMCID: PMC10154159 DOI: 10.1111/1475-6773.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE To assess Muslim physician experiences with religious discrimination and identify strategies for better accommodating Muslim identity in health care. DATA SOURCES AND STUDY SETTING Interviews were conducted with Muslim physicians from three US-based Muslim clinician organizations between June and August 2021. STUDY DESIGN In-depth, semi-structured qualitative interviews used a phenomenological approach to describe experiences of religious discrimination and accommodation. A team-based framework approach to coding was used to inductively generate themes from interview data. DATA COLLECTION/EXTRACTION METHODS Physicians from the Islamic Medical Association of North America, American Muslim Health Professionals, and the US Muslim Physicians group were invited to participate using closed organizational listservs. Inclusion criteria sought English-speaking, self-identifying Muslims with current or past affiliation with a university hospital in the United States. Potential participants were segmented into groups based on responses to questions about perceived religious discrimination and accommodation. Purposive sampling was used to iteratively approach participants within these groups in order to capture a diverse respondent pool. Interviews stopped after thematic saturation was reached. PRINCIPAL FINDINGS Eighteen physicians (11 women and 7 men; mean age: 41.5 [standard deviation = 12.91] years) were interviewed. Nearly all (n = 16) held Islam to be important in their lives. Three overarching themes, with several subthemes, emerged. Participants (1) struggled to maintain religious practices and observances due to unaccommodating organizational structures; (2) experienced religious discrimination, which, in turn, impacted their professional trajectories and, at times, their personal well-being; and (3) believed that institutions could implement specific educational and policy interventions to advance the religious accommodation of Muslims in health care. CONCLUSIONS Muslim physicians frequently encounter religious discrimination, yet there are concrete ways in which health care workplaces can better accommodate their religious needs and combat discrimination. To improve workforce diversity, equity, and inclusion, educational forums and policies that support the religious practices of physicians need to be established.
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Affiliation(s)
- Aasim I. Padela
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
- Initiative on Islam and MedicineBrookfieldWisconsinUSA
| | - Laila Azam
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
- Initiative on Islam and MedicineBrookfieldWisconsinUSA
| | - Sohad Murrar
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
- Initiative on Islam and MedicineBrookfieldWisconsinUSA
- Department of PsychologyUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Benish Baqai
- Department of Emergency MedicineMedical College of WisconsinMilwaukeeWisconsinUSA
- Initiative on Islam and MedicineBrookfieldWisconsinUSA
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George LS, Epstein RM, Akincigil A, Saraiya B, Trevino KM, Kuziemski A, Pushparaj L, Policano E, Prigerson HG, Godwin K, Duberstein P. Psychological Determinants of Physician Variation in End-of-Life Treatment Intensity: A Systematic Review and Meta-Synthesis. J Gen Intern Med 2023; 38:1516-1525. [PMID: 36732436 PMCID: PMC10160244 DOI: 10.1007/s11606-022-08011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized. OBJECTIVE Conduct a review of qualitative studies to explicate whether and how psychological propensities could result in some physicians providing more intensive treatment than others. METHODS Systematic searches were conducted in five major electronic databases-MEDLINE ALL (Ovid), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (Ovid), and Cochrane CENTRAL (Wiley)-to identify eligible studies (earliest available date to August 2021). Eligibility criteria included examination of a physician psychological factor as relating to end-of-life care intensity in advanced life-limiting illness. Findings from individual studies were pooled and synthesized using thematic analysis, which identified common, prevalent themes across findings. RESULTS The search identified 5623 references, of which 28 were included in the final synthesis. Seven psychological propensities were identified as influencing physician judgments regarding whether and when to withhold or de-escalate life-extending treatments resulting in higher treatment intensity: (1) professional identity as someone who extends lifespan, (2) mortality aversion, (3) communication avoidance, (4) conflict avoidance, (5) personal values favoring life extension, (6) decisional avoidance, and (7) over-optimism. CONCLUSIONS Psychological propensities could influence physician judgments regarding whether and when to de-escalate life-extending treatments. Future work should examine how individual and environmental factors combine to create such propensities, and how addressing these propensities could reduce physician-attributed variation in end-of-life care intensity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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4
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Linando JA. A relational perspective comparison of workplace discrimination toward Muslims in Muslim-minority and Muslim-majority countries. INTERNATIONAL JOURNAL OF CROSS CULTURAL MANAGEMENT 2022. [DOI: 10.1177/14705958221120990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research on discrimination and inequality has seen a significant increase in workplace religious discrimination toward Muslims. However, it is not well understood how macro-societal, meso-organizational and micro-individual factors contribute to workplace discrimination toward Muslims. Using a systematic literature review (SLR), this study analyses 134 articles to frame a comparative lens of discrimination toward Muslims in Muslim-minority and Muslim-majority countries. This study reveals different discrimination patterns in both country types. In Muslim-minority countries, only the macro-societal level factors are consistently linked to blatant discrimination form while the other two levels (meso-organizational and micro-individual) contribute towards a mixture of blatant and subtle discrimination incidents. Meanwhile, Muslim-majority countries' discrimination cases specifically occur towards women in subtle manners at each level. The different discrimination patterns in the two country types also leads to other notions such as the logic of in-group discrimination toward Muslim women in Muslim-majority countries and the repositioning of gender and religious identities.
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Harper DM, Sen A, Tariq M, Khoury CE, Haro EK, Alman E, Patel MR, Resnicow K. Concordant physician-patient characteristics lose importance for Arab American women and their healthcare- cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100225. [PMID: 35765541 PMCID: PMC9236211 DOI: 10.1016/j.lana.2022.100225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Arab American women have preferred women physicians of their own culture in the past. The primary aim of this study is to determine the current influence of religion/culture among MENA women and their preferences for physicians of same sex, culture, and religion on the avoidance and uncomfortableness of routine and women's health exams. Methods A cross sectional community survey including religiosity and the importance of physician matched sex, culture, and religion was completed. Outcome measures were avoidance of a routine physical exam, or a women's health exam because of religious/cultural issues; and the uncomfortableness of the women's health exam. Linear regression modeling was used to evaluate the association between outcomes and potential predictors, with significance assessed using a bootstrap method. Findings The responses of 97 MENA women 30-65 years old showed that MENA women agreed that they would avoid routine health exams because of religious/cultural issues if their physician was of the same religion or culture as they were (p < 0.001, p < 0.05, respectively) or they had less education (p < 0.05). MENA women also avoided women's health exams due to religious/cultural issues if her physician was of the same religion as she (p < 0.01). Interpretation MENA women 30-65 years old may no longer be bound to a female physician of their same religion/culture for their health exams.
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Affiliation(s)
- Diane M Harper
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, 1018 Fuller Street, MI 48104, USA,Department of Obstetrics & Gynecology, University of Michigan School of Medicine, Ann Arbor, MI, USA,Department of Women’s Studies, College of Literature, Science and the Arts, University of Michigan, Ann Arbor, MI, USA,Corresponding author at: Department of Family Medicine, University of Michigan School of Medicine, 1018 Fuller Street, Ann Arbor MI 48105, USA. (D.M. Harper)
| | - Ananda Sen
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, 1018 Fuller Street, MI 48104, USA,School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Madiha Tariq
- Arab Community Center for Economic and Social Services (ACCESS), Dearborn, MI, USA
| | - Christelle El Khoury
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, 1018 Fuller Street, MI 48104, USA
| | - Elizabeth K. Haro
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, 1018 Fuller Street, MI 48104, USA
| | - Emma Alman
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, 1018 Fuller Street, MI 48104, USA
| | - Minal R. Patel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ken Resnicow
- Outreach and Health Disparities Research, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA,Center for Health Communications Research, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Pratt R, Ojo-Fati O, DuBois D, Okuyemi K, Graham AL, Mohamed S, Janowiec M, Kahin A, Mahamud A, Tessier KM, Busch AM, Joseph AM. Testing the Feasibility and Acceptability of a Religiously-Tailored Text Messaging Intervention to Reduce Smoking Among Somali Muslim Men During Ramadan. Nicotine Tob Res 2021; 23:1283-1290. [PMID: 33277991 PMCID: PMC8496498 DOI: 10.1093/ntr/ntaa260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The prevalence of smoking among Somali Muslim male immigrants residing in Minnesota is estimated at 44%, however smoking reduction is common during the month of Ramadan. This study evaluated the feasibility and impact of a religiously tailored text message intervention delivered during Ramadan to encourage smoking reduction among Somali Muslim men who smoke. METHODS Fifty Somali men were recruited. Participants received two text messages per day starting 1 week prior to and throughout the month of Ramadan. Approximately half were religiously tailored and half were about the risks of smoking and benefits of quitting. Smoking behavior was assessed at baseline, and at weeks 4 (end of Ramadan), 8, and 16. Outcomes included feasibility, acceptability, and preliminary impact of the text message intervention on smoking reduction and bioverified abstinence. RESULTS The average age was 41 years. Average time to first cigarette was 1.8 hours at baseline, and 46% of participants smoked menthol cigarettes. Eighteen of 50 participants selected English and 32 selected Somali text messages. Subjects significantly reduced self-reported cigarettes per day (CPD) from 12.4 CPD at baseline to 5.8 CPD at week 16 (p < 0.001). Seven subjects reported quitting at week 16, five completed CO testing, confirming self-reported abstinence. The majority of participants found the cultural and religious references encouraging at the end of the week 16 survey. CONCLUSIONS Religiously tailored text messages to decrease smoking are feasible and acceptable to Somali Muslim men who smoke during Ramadan. This intervention for addressing smoking disparities is worthy of further study. IMPLICATIONS Recruitment of Somali Muslim men who smoke is feasible and supports the idea that further studies targeting smoking during Ramadan are practical. Ramadan presents a window of opportunity upon which to build smoking cessation interventions for smokers who identify as Muslim. These preliminary findings suggest that text messaging is a feasible and acceptable intervention strategy, and that religious tailoring was well received. Such an approach may offer potential for addressing smoking disparities among Somali Muslim male smokers. TRIAL REGISTRATION ClinicalTrial.gov: NCT03379142.
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Affiliation(s)
- Rebekah Pratt
- Department of Family Medicine and Community Health, University of
Minnesota, Minneapolis, MN
| | | | | | - Kolawole Okuyemi
- Department of Family and Preventive Medicine, University of Utah
School of Medicine, Salt Lake City, UT
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington,
DC
- Department of Medicine, Mayo Clinic College of Medicine and
Science, Rochester, MN
| | - Sharif Mohamed
- Islamic Civic Society of America (ICSA), Minneapolis,
MN
| | | | - Abdillahi Kahin
- Department of Medicine, Hennepin Healthcare,
Minneapolis, MN
| | | | - Katelyn M Tessier
- Masonic Cancer Center, Biostatistics Core, University of
Minnesota, Minneapolis, MN
| | - Andrew M Busch
- Department of Medicine, Hennepin Healthcare,
Minneapolis, MN
- Department of Medicine, University of Minnesota,
Minneapolis, MN
| | - Anne M Joseph
- Department of Medicine, University of Minnesota,
Minneapolis, MN
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Obeidat AS, Komesaroff PA. Clinical Ethics from the Islamic Perspective : A qualitative study exploring the views of Jordanian doctors. JOURNAL OF BIOETHICAL INQUIRY 2021; 18:335-348. [PMID: 34132982 DOI: 10.1007/s11673-021-10108-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/14/2021] [Indexed: 06/12/2023]
Abstract
Like other Arab countries, Jordan must find ways of responding to the rapid processes of change affecting many aspects of social life. This is particularly urgent in healthcare, where social and technical change is often manifested in tensions about ethical decision-making in the clinic. To explore the attitudes, beliefs and concerns relating to ethical decision-making among health professionals in Jordanian hospitals, a qualitative study was conducted involving face-to-face interviews with medical personnel in four hospitals in Amman, the capital of Jordan. Data were analysed thematically in relation to a pre-existing set of ethical categories. Interviews were conducted with thirty-eight doctors covering most medical specialities. Five major themes emerged from the interviews: ethical awareness, ethical issues, the impact of religion on ethical decision-making, practical and theoretical resources for ethical decision-making, and challenges. While uncertainty was expressed about some aspects of Western approaches to ethics, participants strongly supported adoption of a range of Western bioethical principles, including cultural and ethical diversity, along with adherence to Islamic religious norms. A range of serious ethical challenges facing the Jordanian health system were identified, covering social, legal, managerial, and technical issues. Ethical decision-making in Jordan is complex, having to accommodate the needs of patients, the opinions of doctors and their families, the views of religious authorities, managerial considerations, and both local norms and international standards. Health professionals struggle with three sets of tensions that emerge out of the struggle between traditional, community-embedded forms of social organization and the demands generated by globalization and the influence of Western culture: the tensions between tradition and modernity, conservatism and pragmatism, and religion and secularism. Doctors in Jordan prefer approaches to ethical decision-making that realize a balance between the extremes, although the exact nature of where that balance should lie remains uncertain.
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Affiliation(s)
- Ala S Obeidat
- Monash University, Alfred Hospital, Commercial Road, Prahran, VIC, Australia
| | - Paul A Komesaroff
- Monash University, Alfred Hospital, Commercial Road, Prahran, VIC, Australia.
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Salari P, Larijani B. Publication Trend in Islamic Medical Ethics in Iran and the World: Designing a Road. JOURNAL OF RELIGION AND HEALTH 2021; 60:941-960. [PMID: 33403605 DOI: 10.1007/s10943-020-01154-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
This study aimed at determining the publication trend in Islamic medical ethics; finally, a road map was designed. All published English and Persian papers in Islamic medical ethics were searched until June 2017. Finally, 971 English papers and 204 Persian papers were analyzed. Our results show that publication in Islamic medical ethics started in 1973. The beginning of life was considered the most favorable subject followed by public health and biotechnology by both Iranian and non-Iranian scholars. Taken together, the publication trend in Islamic medical ethics has experienced ups and downs and is not as satisfactory as it should be.
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Affiliation(s)
- Pooneh Salari
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, 23# 16 Azar Ave, Keshavarz Blvd, 1417633114, Tehran, Iran
| | - Bagher Larijani
- Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, 23# 16 Azar Ave, Keshavarz Blvd, 1417633114, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Pratt R, Ojo-Fati O, Adam A, Sharif H, Kahin A, Mahamud A, Dubois D, Mohamed S, Okuyemi K, Graham AL, Joseph A. Text Message Support for Smoking Cessation During Ramadan: A Focus Group Study With Somali Immigrant Muslim Men. Nicotine Tob Res 2019; 22:1636-1639. [DOI: 10.1093/ntr/ntz187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/25/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Somali Muslim male immigrants in Minnesota have a high prevalence of smoking, estimated at 44%, compared with the average smoking rate for adults in the United States (14%). However, the literature has reported spontaneous reductions of smoking during Ramadan. This study sought to gather the views of Somali Muslim men on how faith impacts their smoking, and determine what messaging to incorporate into a tailored text messages intervention that draws on the Muslim faith beliefs and practices during Ramadan to promote smoking cessation.
Methods
Thirty-seven Somali adult male smokers were recruited from community settings to participate in one of five focus groups in Minneapolis and Saint Paul, Minnesota. The research study team developed a semi-structured focus group guide that explored: (1) the experience of Muslim immigrants quitting smoking during Ramadan, (2) views on text messaging interventions to reduce smoking focusing on health and faith, and (3) views on the relationship between faith and smoking. A thematic analysis was conducted.
Results
Participants reported reductions in smoking during Ramadan, which was mostly achieved without formal treatment (ie, willpower). There was interest in text messaging interventions that incorporated faith and health-related messages, and that would be delivered around the time of Ramadan. Participants described concerns about the adverse health effects of smoking, including the risk of chronic health issues, cancer, and death.
Conclusion
Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address smoking disparities in the Somali immigrant community.
Implications
Ramadan offers a unique window of opportunity to intervene upon smoking for Somali Muslim immigrant men, for whom rates of smoking are high. Combining faith and health-related text-based messaging, and tailoring interventions around and beyond Ramadan, maybe a valuable approach to help address these serious smoking disparities.
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Affiliation(s)
- Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | | | - Asma Adam
- School of Medicine, University of Minnesota, Minneapolis, MN
| | - Hiba Sharif
- School of Nursing, University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | | | - Anne Joseph
- Department of Medicine, University of Minnesota, Minneapolis MN
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Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening. J Immigr Minor Health 2019; 22:87-95. [DOI: 10.1007/s10903-019-00881-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duivenbode R, Hall S, Padela AI. Assessing Relationships Between Muslim Physicians’ Religiosity and End-of-Life Health-Care Attitudes and Treatment Recommendations: An Exploratory National Survey. Am J Hosp Palliat Care 2019; 36:780-788. [DOI: 10.1177/1049909119833335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Research demonstrates that the attitudes of religious physicians toward end-of-life care treatment can differ substantially from their nonreligious colleagues. While there are various religious perspectives regarding treatment near the end of life, the attitudes of Muslim physicians in this area are largely unknown. Objective: This article attempts to fill in this gap by presenting American Muslim physician attitudes toward end-of-life care decision-making and by examining associations between physician religiosity and these attitudes. Methods: A randomized national sample of 626 Muslim physicians completed a mailed questionnaire assessing religiosity and end-of-life care attitudes. Religiosity, religious practice, and bioethics resource utilization were analyzed as predictors of quality-of-life considerations, attitudes regarding withholding and withdrawing life-sustaining treatment, and end-of-life treatment recommendations at the bivariate and multivariable level. Results: Two-hundred fifty-five (41% response rate) respondents completed surveys. Most physicians reported that religion was either very or the most important part of their life (89%). Physicians who reported consulting Islamic bioethics literature more often had higher odds of recommending active treatment over hospice care in an end-of-life case vignette. Physicians who were more religious had higher odds of viewing withdrawal of life-sustaining treatment more ethically and psychologically challenging than withholding it and had lower odds of agreeing that one should always comply with a competent patient’s request to withdraw life-sustaining treatment. Discussion: Religiosity appears to impact Muslim physician attitudes toward various aspects of end-of-life health-care decision-making. Greater research is needed to evaluate how this relationship manifests itself in patient care conversations and shared clinical decision-making in the hospital.
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Affiliation(s)
- Rosie Duivenbode
- Initiative on Islam and Medicine, The University of Chicago, Chicago, IL, USA
| | - Stephen Hall
- Initiative on Islam and Medicine, The University of Chicago, Chicago, IL, USA
- Department of Medicine, Section of Emergency Medicine, The University of Chicago, Chicago, IL, USA
| | - Aasim I. Padela
- Initiative on Islam and Medicine, The University of Chicago, Chicago, IL, USA
- Department of Medicine, Section of Emergency Medicine, The University of Chicago, Chicago, IL, USA
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Padela AI, Qureshi O. Islamic perspectives on clinical intervention near the end-of-life: We can but must we? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2017; 20:545-559. [PMID: 27613411 DOI: 10.1007/s11019-016-9729-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The ever-increasing technological advances of modern medicine have increased physicians' capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new "types" of living where a patient's cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care. For some patients and clinicians, religious teachings about the duty to seek medical care and the care of the dying offer ethical guidance when faced with such choices. Accordingly, this paper argues that traditional Sunni Islamic ethico-legal views on the obligation to seek medical care and Islamic theological concepts of human dignity (karāmah) and inviolability (ḥurmah) provide the ethical grounds for non-intervention at the end-of-life and can help calibrate goals of care discussions for Muslim patients. In closing the paper highlights the pressing need to develop a holistic ethics of healthcare of the dying from an Islamic perspective that brings together multiple genres of the Islamic intellectual tradition so that it can meet the needs of the patients, clinicians and Muslim religious leaders interacting with the healthcare system.
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Affiliation(s)
- Aasim I Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, University of Chicago, 5841 S. Maryland Ave, MC 5068, Chicago, IL, 60637, USA.
- Section of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA.
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Janků T, Linhartová L, Topinka D. Practice of Nursing Care Provided to Clients from Muslim Countries in the Czech Republic. JOURNAL OF RELIGION AND HEALTH 2017; 56:1658-1669. [PMID: 27350010 DOI: 10.1007/s10943-016-0273-0] [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: 06/06/2023]
Abstract
Authors deal with practice of nursing care provided to Muslim clients in the Czech Republic. They use the explorative research design. By means of analyses of 21 semi-structured interviews with important social actors in the area of health care (spa resorts and hospitals). The study shows that Muslims are not homogeneous in their behaviour in the field of health care. In the spa environment, three interpretation perspectives can be found: the economic interpretation of a Muslim as the source of income of the Czech spa industry, which faces economic problems, the cultural interpretation developed within the spas (the experience capital of the staff and other clients), and the (a) cultural interpretation of Muslims and Islam brought to spas from the outside (the public opinion). However, in the area of hospitals, Muslims are not separated from the remaining categories of students; Muslim patients represent a small group of persons, and their treatment being conditioned by the distance or closeness of cultures, language skills, adaptation, and experiences with treatment in the Czech environment as perceived by the staff.
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Affiliation(s)
- Tomáš Janků
- SocioFactor s.r.o., Jiráskova 222/18, 602 00, Brno, Czech Republic.
| | - Lenka Linhartová
- SocioFactor s.r.o., Jiráskova 222/18, 602 00, Brno, Czech Republic
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Ekmekci PE. Abortion in Islamic Ethics, and How it is Perceived in Turkey: A Secular, Muslim Country. JOURNAL OF RELIGION AND HEALTH 2017; 56:884-895. [PMID: 27364347 PMCID: PMC5215975 DOI: 10.1007/s10943-016-0277-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Abortion is among the most widely discussed concepts of medical ethics. Since the well-known ethical theories have emerged from Western world, the position of Islamic ethics regarding main issues of medical ethics has been overlooked. Muslims constitute a considerable amount of world population. Turkish Republic is the only Muslim country ruled with secular democracy and one of the three Muslim countries where abortion is legalized. The first aim of this paper is to present discussions on abortion in Islamic ethics in the context of major ethical concepts; the legal status of the fetus, respect for life and the right not to be born. The second aim is to put forth Turkey's present legislation about abortion in the context of Islamic ethical and religious aspects.
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Affiliation(s)
- Perihan Elif Ekmekci
- Department of History of Medicine and Ethics, Faculty of Medicine, TOBB University of Economics and Technology, Söğütözü, Söğütözü Cd. No:43, 06560, Ankara, Turkey.
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Pratt R, Mohamed S, Dirie W, Ahmed N, VanKeulen M, Ahmed H, Raymond N, Okuyemi K. Views of Somali women and men on the use of faith-based messages promoting breast and cervical cancer screening for Somali women: a focus-group study. BMC Public Health 2017; 17:270. [PMID: 28320350 PMCID: PMC5359974 DOI: 10.1186/s12889-017-4182-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screening rates for breast and cervical cancer for Muslim women in the United States are low, particularly for first-generation immigrants. Interpretations of the Muslim faith represent some of the barriers for breast and cervical cancer screening. Working to understand how faith influences breast and cervical screening for Somali women, and working with the community to identify and utilize faith-based assets for promoting screening, may lead to life-saving changes in screening behaviors. METHODS We partnered with an Imam to develop faith-based messages addressing the concerns of modesty and predetermination and promoting cancer testing and screening. A total of five focus groups were convened, with 34 Somali women (three groups) and 20 Somali men (two groups). Each focus group first discussed participant views of breast and cervical cancer screening in general and then viewed and discussed video clips of the Imam delivering the faith-based messages. RESULTS Both Somali women and men had an overwhelmingly positive response to the faith-based messages promoting breast and cervical cancer screening. The faith-based messages appeared to reinforce the views of those who were already inclined to see screening positively, with participants describing increased confidence to engage in screening. For those who had reservations about screening, there was feedback that the faith-based messages had meaningfully influenced their views. CONCLUSIONS Somali immigrant women and men found faith-based messages addressing topics of predestination and modesty and encouraging the use of screening and treatment to be both acceptable and influential. Faith can play an important role as an asset to promote breast and cervical cancer screening, and there may be substantial benefits to adding faith-based messaging to other interventions that focus on improving screening uptake. This may help to address health disparities for Somali women in this area.
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Affiliation(s)
- Rebekah Pratt
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA.
| | | | - Wali Dirie
- Islamic Civil Society of America, Minneapolis, USA
| | - Nimo Ahmed
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | | | - Huda Ahmed
- Program in Health Disparities Research, University of Minnesota, Minneapolis, USA
| | - Nancy Raymond
- Powell Center for Women's Health, Department of Psychiatry, University of Minnesota, Minneapolis, USA
| | - Kola Okuyemi
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
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Mahdi S, Ghannam O, Watson S, Padela AI. Predictors of Physician Recommendation for Ethically Controversial Medical Procedures: Findings from an Exploratory National Survey of American Muslim Physicians. JOURNAL OF RELIGION AND HEALTH 2016; 55:403-21. [PMID: 26613589 DOI: 10.1007/s10943-015-0154-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Physician religiosity can influence their ethical attitude toward medical procedures and can thereby impact healthcare delivery. Using a national survey of American Muslim physicians, we explored the association between physician recommendation of three controversial medical procedures--tubal ligation, abortion, and porcine-based vaccine--and their (1) religiosity, (2) utilization of bioethics resources, and (3) perception of whether the procedure was a medical necessity and if the scenario represented a life threat. Generally, multivariate models found that physicians who read the Qur'an more often as well as those who perceived medical necessity and/or life threat had a higher odds recommending the procedures, whereas those who sought Islamic bioethical guidance from Islamic jurists (or juridical councils) more often had a lower odds. These associations suggest that the bioethical framework of Muslim physicians is influenced by their reading of scripture, and the opinions of Islamic jurists and that these influences may, paradoxically, be interpreted to be in opposition over some medical procedures.
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Affiliation(s)
- Sundus Mahdi
- The Centre for Islam and Medicine, Cambridge, UK
| | - Obadah Ghannam
- The Centre for Islam and Medicine, Cambridge, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sydeaka Watson
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Aasim I Padela
- Initiative on Islam and Medicine, Program on Medicine and Religion, The University of Chicago, Chicago, IL, USA.
- Section of Emergency Medicine, Department of Medicine, The University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.
- The Initiative on Islam and Medicine, Section of Emergency Medicine, 5841 South Maryland Ave., MC 5068, Chicago, IL, 60637, USA.
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Pratt R, Fadumo A, Hang M, Osman S, Raymond N. Perceptions of mental illness in the Somali community in Minnesota. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2016. [DOI: 10.1108/ijmhsc-04-2014-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Somali immigrants are a strong, vibrant community in the Twin Cities area of Minnesota. However, the legacy of resettlement and the challenges of adjustment can lead to complex physical and mental health challenges. The Somali community is considered to be underserved, particularly with regard to mental health, but the health system must understand the perception of mental health in the Somali community in order to address current disparities. The paper aims to discuss these issues.
Design/methodology/approach
– This qualitative research drew on the Social Ecological Model (SEM) and was conducted with the goal of learning more about how mental illness is perceived in the Somali community living in Minnesota. Four focus groups were held, with a total of 35 participants, 19 female and 16 male.
Findings
– Several main themes emerged from the data. The community’s foundations of the perceptions of mental health inform and shape their perspective on mental illness, including the way mental illness is defined. Historical experiences, the impact of trauma, strong religious beliefs, and stigma toward mental illness influenced both the perceived causes of mental illness and views on seeking treatment.
Originality/value
– This research suggests there is value in drawing on the SEM to as the perception of mental illness is both layered, and shaped by the Somali community’s historical and social context. Forming community partnerships that address concerns about mental illness are essential next steps toward improving mental health in the Somali community. These partnerships should build on existing community assets, particularly religious leaders.
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Shabana A. Religious and cultural legitimacy of bioethics: lessons from Islamic bioethics. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:671-677. [PMID: 23397216 DOI: 10.1007/s11019-013-9472-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Islamic religious norms are important for Islamic bioethical deliberations. In Muslim societies religious and cultural norms are sometimes confused but only the former are considered inviolable. I argue that respect for Islamic religious norms is essential for the legitimacy of bioethical standards in the Muslim context. I attribute the legitimating power of these norms, in addition to their purely religious and spiritual underpinnings, to their moral, legal, and communal dimensions. Although diversity within the Islamic ethical tradition defies any reductionist or essentialist reconstruction, legitimacy is secured mainly by approximation of Islamic ethical ideals believed to be inherent in the scriptural texts, rather than by the adoption of particular dogmatic or creedal views. With these characteristics, Islamic (bio) ethics may provide useful insights for comparative ethics and global bioethics.
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Affiliation(s)
- Ayman Shabana
- Georgetown University's School of Foreign Service in Qatar, Education City, PO BOX 23689, Doha, Qatar,
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Sandvik H, Hunskaar S, Diaz E. Clinical practice patterns among native and immigrant doctors doing out-of-hours work in Norway: a registry-based observational study. BMJ Open 2012; 2:e001153. [PMID: 22798255 PMCID: PMC3400071 DOI: 10.1136/bmjopen-2012-001153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 06/25/2012] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate whether immigrant and native Norwegian doctors differ in their practice patterns. DESIGN Observational study. SETTING Out-of-hours (OOH) emergency primary healthcare in Norway, 2008. PARTICIPANTS All primary care physicians doing OOH work, altogether 4165 physicians. MAIN OUTCOME MEASURES Number of patient contacts per doctor. Use of laboratory tests, minor surgery, sickness certification and length of consultations. Use of diagnoses related to psychiatric and sexual health. Choice of management strategy with psychiatric patients (psychotherapy or hospitalisation). RESULTS 21.4% of the physicians were immigrants, and they had 30.6% of the patient contacts. Immigrant doctors from Asia, Africa and Latin America had most patient contacts, 633 (95% CI 549 to 716), while native Norwegian doctors had 306 (95% CI 288 to 325). In multivariate analyses, immigrant physicians did not differ significantly from native Norwegians regarding use of laboratory tests, minor surgery or length of consultations, but immigrant doctors wrote more sickness certificates, OR 1.75 (95% CI 1.24 to 2.47) for immigrant doctors from Europe, North America and Oceania versus native Norwegian doctors and OR 1.56 (95% CI 1.15 to 2.11) for immigrant doctors from Asia, Africa and Latin America versus native Norwegians. Immigrant physicians from Europe, North America and Oceania used more diagnoses related to pregnancy, family planning and female genitals, OR 1.55 (95% CI 1.11 to 2.16), versus native Norwegian physicians. Immigrant doctors from Asia, Africa and Latin America used less psychiatric diagnoses, OR 0.71 (95% CI 0.53 to 0.95), versus native Norwegian doctors but did not differ significantly in their management of recognised psychiatric illness. CONCLUSIONS Immigrant doctors make an important contribution to OOH emergency primary healthcare in Norway. The authors found only modest evidence that their clinical practice patterns are different from that of native Norwegian doctors.
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Affiliation(s)
- Hogne Sandvik
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, Uni Health, Uni Research and Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
| | - Esperanza Diaz
- Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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Díaz E, Hjörleifsson S. Immigrant general practitioners in Norway: a special resource? A qualitative study. Scand J Public Health 2011; 39:239-44. [PMID: 21270138 DOI: 10.1177/1403494810395818] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To explore whether and how immigrant general practitioners (GPs) in two major cities in Norway think that their own ethnic background affects their practices and their work. METHODS Qualitative focus group and individual interviews with seven immigrant GPs, five men and two women, age 36-65 years. Their clinical experience in Norwegian primary health care ranged from four to 30 years. Analysis was conducted by systematic text condensation. RESULTS First, immigrant GPs described a gradual process of becoming bicultural: the GPs communicate with immigrant patients on their own terms and draw upon their special knowledge from abroad to help selected patients, while also adapting to Norwegian cultural expectations of the GP's role. Second, the GPs described being aware of cultural issues in consultations with immigrant and Norwegian patients, but rarely making these issues explicit. The GPs ventured that cultural awareness, together with their personal experience in their own countries and as immigrants in Norway, made them able to sometimes help immigrant patients better than Norwegian GPs. Third, immigrant GPs experienced a big workload related to immigrant patients, but they accepted this as a natural part of their work. Fourth, immigrant GPs felt that they had to work harder and be more careful than their Norwegian colleagues in order to avoid complaints from patients, and to be accepted by colleagues. CONCLUSIONS Immigrant GPs express broad cultural competence and keen cultural awareness in their consultations. The immigrant background of these GPs could be considered as a special resource for clinical practice.
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Affiliation(s)
- Esperanza Díaz
- Research Group for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Norway.
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