Screaming silences: lessons from the application of a new research framework

Exploring the experiences of children's palliative care for forced migrant families in the United Kingdom: an interpretative phenomenological study

Introduction

This study focused on understanding the experiences of forced migrant families and the health care professionals who care for them within palliative care. Palliative care for children requires an active, holistic approach to care, with a focus upon improving quality of life. Forced migrant families encounter a range of additional challenges including the loss of family, belongings, and all sources of familiarity and support. The difficulties of navigating complex bureaucratic systems can confound access and communication difficulties.

Methods

Interpretative Phenomenological Analysis methodology was used in this study to privilege participant perspectives and apply an active in-depth cyclical process of reflection and reflexivity. Advisory group members provided expertise in childhood illness, palliative care and forced migration, throughout the study. The Silences Framework offered novel theoretical and philosophical concepts, which helped to situate and prioritise the "silences" within the marginalised discourses of forced migration and palliative care. Seven family members and seven health care professional participants were interviewed from hospital, hospice and community palliative care settings in the UK.

Results

Four overarching themes were identified related to experiences of loss and grief, communication, faith and coping strategies and alienation and discrimination. Compassionate, empathetic, family-centred care which valued family belief systems and coping strategies, optimised care. Learning with and from families was described by all participants, which enhanced understanding and fostered mutual respect. However, barriers included poor access to services and resources, protocol-led care, limited time with families, communication barriers and staff burnout.

Discussion

The findings suggest the need for a specific educational pathway for palliative care professionals to include spiritual care provision, cultural humility, and moral reasoning. Interdisciplinary education including the use of lived-experience expert insights is also advocated. Sufficient time to build relationships, the importance of interpreter support and the need for better access to hospice care for forced migrant families is also recommended.

'Hearing silences': Exploring culturally safe transitional care: A qualitative study among Turkish-speaking migrant frail older adults

AIMS

This study aimed to investigate the experiences and transitional care needs of Turkish frail older adults living in the UK and determine how this information can be utilized to improve the provision of culturally sensitive care during the transitional period.

DESIGN

Qualitative descriptive research with semi-structured individual interviews.

METHODS

"The 'Silences' Framework guided the research design, from conceptualizing the research question to structuring the report of final outputs. For this study, semi-structured, in-depth interviews were conducted with sixteen older adults living with frailty and five family caregivers between January and May of 2023 in the United Kingdom.

RESULTS

Major themes that were identified included: (i) information and communication, (ii) care and support, (iii) the role of culture and (iv) trust and satisfaction. Further analysis, through discussion and immersion in the data, revealed that care transition periods were presented alongside three phases of transitional care: pre-transition (during hospitalization), early-transition (the period between discharge and the 7th day after discharge) and late transition (the period between the 8th day and 12th month after discharge).

CONCLUSIONS

Our study revealed that the communication and informational needs of frail older individuals change during the transition period. While Turkish older adults and family caregivers expressed satisfaction with healthcare services in the UK, many struggled due to a lack of knowledge on how to access them.

IMPACT

The support of family caregivers is a crucial component in facilitating transitional care for frail older patients, as they help in accessing healthcare services and using technological devices or platforms. It should be noted that family caregivers often hold the same level of authority as their elderly Turkish counterparts.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.