1
|
Erdsiek F, Yılmaz-Aslan Y, Brzoska P. Participatory development of a manual for the implementation of diversity-sensitive palliative and hospice care in Germany: a mixed-methods study protocol. BMC Palliat Care 2023; 22:128. [PMID: 37670296 PMCID: PMC10478178 DOI: 10.1186/s12904-023-01252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The diversity of the population is associated with different needs and expectations towards palliative and hospice care. Current approaches available in Germany generally fall short in addressing the role of diversity and intersectionality in this health care setting and healthcare facilities struggle with organizational difficulties and missing information on how to implement corresponding diversity-sensitive measures. The present study aims to develop a hands-on manual that enables providers of hospice and palliative care to implement measures and strategies for diversity-sensitive care, while taking into account the perspective of healthcare users and explicitly including vulnerable and minority patient groups. METHODS A participatory approach is used to co-create the aforementioned manual using an explanatory sequential mixed-methods design. First, based on a systematic analysis of existing measures, an initial draft of the manual will be developed. Subsequently, an online survey will be conducted among all hospice and palliative care providers in Germany (n = 2,823). Based on the results of the survey, 12 to 15 qualitative problem-centered interviews will be conducted with employees of selected providers who took part in the survey. Results of the survey and the qualitative interviews will be integrated and analyzed. In parallel to the development and research process, a comprehensive dissemination strategy will be developed. DISCUSSION The manual will assist providers of palliative and hospice care in determining goals, needs, and available resources in order to utilize patient-centered and diversity-sensitive measures to meet a wide range of expectations. It can also be informative for providers in other countries. The participatory co-development approach ensures the practical relevance of the manual, while the mixed-methods design allows for targeted input on the manual's usability, acceptance, and viability as a supportive tool.
Collapse
Affiliation(s)
- Fabian Erdsiek
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Patrick Brzoska
- Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| |
Collapse
|
2
|
Lundberg E, Ozanne A, Larsdotter C, Böling S, Dellenborg L, Ensted D, Öhlén J. Place of death among foreign-born individuals: a national population-based register study. Palliat Care Soc Pract 2023; 17:26323524231185157. [PMID: 37465177 PMCID: PMC10350762 DOI: 10.1177/26323524231185157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/12/2023] [Indexed: 07/20/2023] Open
Abstract
Background Relatively little is known about where foreign-born individuals die in Sweden and how birth region might influence place of death. Thus, there is a need for population-based studies investigating place of death and associated factors among foreign-born individuals. Objectives The aim of this study was to identify variations in place of death among foreign-born individuals residing in Sweden and to compare place of death between the foreign- and domestic-born population. We also examine the association between place of death, underlying cause of death and sociodemographic characteristics among the foreign-born population. Design A population-based register study. Methods All deceased individuals ⩾18 years of age in Sweden with a registered place of death between 2012 and 2019 (n = 682,697). Among these, 78,466 individuals were foreign-born. Univariable multinomial logistic regression modelling and multivariable multinomial logistic regression analyses were performed. Results Overall, hospital was the most common place of death among the foreign-born population. However, there were variations in place of death related to region of birth. Compared to domestic-born, a higher proportion of foreign-born individuals dies at home, the majority of whom were born on the African continent. Conclusion Region of birth is one of the several factors associated with place of death among foreign-born individuals. Further research is needed to explore both preferences and barriers to place of death among foreign-born individuals.
Collapse
Affiliation(s)
| | - Anneli Ozanne
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Susanna Böling
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisen Dellenborg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Ensted
- Department of Literature, History of Ideas, and Religion, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Palliative Centre, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
3
|
Latif Z, Makuvire T, Feder SL, Abrahm J, Quintero Pinzon P, Warraich HJ. Experiences of Medical Interpreters During Palliative Care Encounters With Limited English Proficiency Patients: A Qualitative Study. J Palliat Med 2023; 26:784-789. [PMID: 36516127 PMCID: PMC11079501 DOI: 10.1089/jpm.2022.0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background: There are many challenges in communication and cultural barriers for patients with limited English proficiency (LEP) who suffer from serious illnesses. Palliative care utilization among this population remains limited and the experiences of medical interpreters during palliative care encounters remain understudied. Methods: We conducted semistructured video interviews with interpreters working at an academic medical center. Interview questions explored interpreters' observations and experiences during palliative care encounters with LEP patients. We performed thematic analysis of the interview contents. Results: Our study included 20 interpreters who interpret in 9 languages with a mean experience of 16.3 years. We identified four themes from the interviews that shed light on the challenges of incorporating palliative care into the care of patients with LEP: (1) lack of a verbatim interpretation for the term "palliative care," (2) poor patient understanding of their treatment goals, (3) suboptimal timing of palliative care involvement, and (4) fears and misconceptions related to palliative care. Owing to challenges in word choice, the timing of palliative care involvement, and poor understanding of palliative care, interpreters observed that many patients with LEP declined palliative care involvement in their treatment plan. Conclusions: In this study, we identified several actionable barriers interpreters noted to incorporating palliative care into care of patients with LEP. Interventions directed toward providing LEP patients with standardized culturally appropriate information on palliative care are needed.
Collapse
Affiliation(s)
- Zara Latif
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Makuvire
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Janet Abrahm
- Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pablo Quintero Pinzon
- Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Haider J. Warraich
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Shabnam J, Timm HU, Nielsen DS, Raunkiaer M. Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families. Eur J Oncol Nurs 2023; 62:102238. [PMID: 36459811 DOI: 10.1016/j.ejon.2022.102238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark. METHODS The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark. RESULTS The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care. CONCLUSION This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.
Collapse
Affiliation(s)
- Jahan Shabnam
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Helle Ussing Timm
- National Institute of Public Health, University of Southern Denmark, Studiestraede 6, 1455, Copenhagen, K, Denmark; University Hospitals Center for Health Research (UCSF), Rigshospital, Denmark.
| | - Dorthe Susanne Nielsen
- Geriatric Department G, Odense, Odense University Hospital, Kløvervænget 23, 5000, Odense C, Denmark.
| | - Mette Raunkiaer
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Vestergade 17, 5800 Nyborg, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| |
Collapse
|
5
|
Adsersen M, Thygesen LC, Kristiansen M, Hansen MB, Neergaard MA, Petersen MA, Groenvold M. Higher overall admittance of immigrants to specialised palliative care in Denmark: a nationwide register-based study of 99,624 patients with cancer. Support Care Cancer 2023; 31:132. [PMID: 36695904 DOI: 10.1007/s00520-023-07597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The population of immigrants in Europe is ageing. Accordingly, the number of immigrants with life-threatening diseases and need for specialised palliative care will increase. In Europe, immigrants' admittance to specialised palliative care is not well explored. AIM To investigate whether country of origin was associated with admittance to (I) palliative care team/unit, (II) hospice, and/or (III) specialised palliative care, overall (i.e. palliative care team/unit and/or hospice). DESIGN Data sources for the population cohort study were the Danish Palliative Care Database and several nationwide registers. We investigated the associations between country of origin and admittance to specialised palliative care, overall, and to type of palliative care using logistic regression analyses. SETTING/PARTICIPANTS In 2010-2016, 104,775 cancer patients died in Denmark: 96% were born in Denmark, 2% in other Western countries, and 2% in non-Western countries. RESULTS Overall admittance to specialised palliative care was higher for immigrants from other Western (OR = 1.13; 95%CI: 1.03-1.24) and non-Western countries (OR = 1.22; 95%CI: 1.08-1.37) than for the majority population. Similar results were found for admittance to palliative care teams. No difference in admittance to hospice was found for immigrants from other Western countries (OR = 1.04; 95%CI: 0.93-1.16) compared to the majority population, while lower admittance was found for non-Western immigrants (OR = 0.70; 95%CI: 0.60-0.81). CONCLUSION Admittance to specialised palliative care was higher for immigrants than for the majority population as higher admittance to palliative care teams for non-Western immigrants more than compensated for the lower hospice admittance. This may reflect a combination of larger needs and that hospital-based and home-based services are perceived as preferable by immigrants.
Collapse
|
6
|
Latif Z, Makuvire T, Feder SL, Crocker J, Quintero Pinzon P, Warraich HJ. Forgotten in the crowd: A qualitative study of medical interpreters' role in medical teams. J Hosp Med 2022; 17:719-725. [PMID: 35912708 DOI: 10.1002/jhm.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) experience worse outcomes compared with native English speakers. Communication errors are partly responsible for the disparities among this population. Medical interpreters improve communication and often assume multiple roles during clinical encounters. We sought to explore the perspectives of medical interpreters regarding their role within medical teams and ways to improve communication. METHODS We conducted a qualitative study using semistructured interviews with inpatient and outpatient medical interpreters at an academic medical center between March and August 2021. Interview questions explored interpreters' perceptions of their roles within the medical team and best practices to improve communication during encounters. Interview transcripts were analyzed using thematic analysis. RESULTS Our sample consisted of 20 interpreters with a mean age of 48 years (SD: 14.3) and a mean experience of 16.3 years (SD: 10.6). Two main themes emerged from interviews: (1) the full spectrum of medical interpreters' role and (2) factors acting as barriers and facilitators of interpretation. Interpreters described their role as language interpreters, cultural mediators, and patient advocates. They also identified several factors that may enhance encounters, such as utilizing the teach-back method with patients and debriefing with interpreters. CONCLUSIONS Interpreters view their role as extending beyond interpretation to include cultural mediation and patient advocacy. Addressing commonly encountered challenges and adopting some of the proposed solutions highlighted in this study may facilitate improved communication with LEP patients receiving care in healthcare systems.
Collapse
Affiliation(s)
- Zara Latif
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Makuvire
- Department of Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelli L Feder
- Yale University School of Nursing, Orange, Connecticut, USA
| | - Jonathan Crocker
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pablo Quintero Pinzon
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Haider J Warraich
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW To summarize results of recent studies of migrants in Europe and North America and ongoing efforts to adapt strategies to provide them with inclusive sensitive health care. RECENT FINDINGS Major predisposing factors for developing hypertension, obesity, diabetes, and the metabolic syndrome in migrating populations and refugees were identified. Susceptibility to the metabolic syndrome is predominantly due to environmental factors and psychological stress. Acculturation also contributes to the emergence of cardiovascular (CV) risk factors in first-generation adult immigrants. Increased risk for later development of hypertension and dyslipidemia has also been detected in adolescent immigrants. Targets for public health efforts were based on data that show important differences in CV risk factors and prevalence of the metabolic syndrome among ethnic immigrant groups. Studies in young adults focused on lifestyle and dietary behaviors and perceptions about weight and body image, while the focus for older adults was end-of-life issues. Two important themes have emerged: barriers to health care, with a focus on cultural and language barriers, and violence and its impact on immigrants' mental health.
Collapse
Affiliation(s)
- Talma Rosenthal
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rhian M Touyz
- Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Suzanne Oparil
- Vascular Biology & Hypertension Program, Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-0007, USA.
| |
Collapse
|
8
|
Carlsson ME, Hjelm K. Equal palliative care for foreign-born patients: A national quality register study. Palliat Support Care 2021; 19:656-663. [PMID: 34092275 DOI: 10.1017/s1478951521000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To use data from a national quality register to investigate if there are differences relating to migrant background in the quality of end-of-life care of patients dying in Sweden. METHODS A retrospective, comparative register-based study. In total, 81,418 deceased patients, over 18 years of age, registered in the Swedish Register of Palliative Care during 2017 and 2018, of expected death were included in the study. Of these, 72,012 were Swedish-born and 9,395 were foreign-born. Descriptive and analytical statistical methods were used. RESULTS No general pattern of differences in quality regarding end-of-life care was found between Swedish- and foreign-born patients. There were several significant differences in various quality indicators but not in a specific direction. Sometimes, the quality indicators showed an advantage for Swedish-born patients but just as often, they were also favorable for foreign-born patients. Swedish-born patients had greater access to specialized palliative care than foreign-born patients. Foreign-born patients were more often cared for in general home care setting, despite a higher frequency of cancer diagnosis. SIGNIFICANCE OF RESULTS Foreign-born patients were less likely to be cared for in specialized palliative care units and had poorer access to palliative care teams than Swedish-born patients, despite having a higher proportion of cancer diagnoses. However, no general pattern was found indicating that foreign-born patients were disadvantaged in the quality indicators measured in the present study. Perhaps, this is an indication that the palliative care in Sweden is individualized; nonetheless, the quality of end-of-life care would be higher if dying patients, regardless of country of birth, have better access to specialized palliative care.
Collapse
Affiliation(s)
- Maria E Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Hjelm
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
9
|
Shabnam J, Timm HU, Nielsen DS, Raunkiaer M. Palliative Care Utilization Among Non-Western Migrants in Europe: A Systematic Review. J Immigr Minor Health 2021. [PMID: 34709528 DOI: 10.1007/s10903-021-01302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants.
Collapse
|
10
|
Hakola OJ. Diversity in Representations and Voices of Terminally Ill People in End-of-Life Documentaries. J Palliat Care 2021; 37:190-196. [PMID: 33940985 PMCID: PMC9109586 DOI: 10.1177/08258597211013961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The 21st century has seen a proliferation of end-of-life
documentary films and television documentaries that contribute to building a
public image of hospice and palliative care. The way in which terminally ill
patients are represented in these documentaries creates impressions of who is
welcomed to receive end-of-life care. These documentary representations have not
been previously mapped. Methods: Using quantitative content
analysis, I analyzed 35 contemporary Western documentaries and studied their
diversity in the representations. I focused on terminally ill patients who are
given time and space in the narration to voice their views about the end-of-life
process. I paid attention to such elements as gender, race and ethnicity, age,
class, religion and sexuality. Results: The documentaries welcomed
the representations and voices of terminally ill people. Class, religion and
sexuality often had a marginal role in narration. The gender diversity of the
representations was quite balanced. Regarding age, the documentaries preferred
stories about working age patients for dramatic purposes, yet all age groups
were represented. However, the documentaries had an identifiable racial and
ethnic bias. With a few exceptions, terminally ill who had a personal voice in
the narrations were white. In comparison, racial and ethnic minorities were
either absent from most of the documentaries, or their role was limited to
illustrations of the general story. Conclusions: End-of-life
documentaries provide identifiable access to the patients’ experiences and as
such they provide emotionally and personally engaging knowledge about hospice
and palliative care. While these representations are people-oriented, they
include racial disparities and they focus mostly on the experiences of white
terminally ill patients. This bias reinforces the misleading image of hospice
and palliative care as a racialized healthcare service.
Collapse
Affiliation(s)
- Outi J Hakola
- Area and Cultural Studies, University of Helsinki, Helsinki, Finland
| |
Collapse
|
11
|
Suarez NRE, Urtecho M, Jubran S, Yeow ME, Wilson ME, Boehmer KR, Barwise AK. The Roles of medical interpreters in intensive care unit communication: A qualitative study. Patient Educ Couns 2021; 104:1100-1108. [PMID: 33168459 PMCID: PMC8068732 DOI: 10.1016/j.pec.2020.10.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 05/22/2023]
Abstract
OBJECTIVES To understand healthcare team perceptions of the role of professional interpreters and interpretation modalities during end of life and critical illness discussions with patients and families who have limited English proficiency in the intensive care unit (ICU). METHODS We did a secondary analysis of data from a qualitative study with semi-structured interviews of 16 physicians, 12 nurses, and 12 professional interpreters from 3 ICUs at Mayo Clinic, Rochester. RESULTS We identified 3 main role descriptions for professional interpreters: 1) Verbatim interpretation; interpreters use literal interpretation; 2) Health Literacy Guardian; interpreters integrate advocacy into their role; 3) Cultural Brokers; interpreters transmit information incorporating cultural nuances. Clinicians expressed advantages and disadvantages of different interpretation modalities on the professional interpreter's role in the ICU. CONCLUSION Our study illuminates different professional interpreters' roles. Furthermore, we describe the perceived relationship between interpretation modalities and the interpreter's roles and influence on communication dynamics in the ICU for patients with LEP. PRACTICE IMPLICATIONS Patients benefit from having an interpreter, who can function as a cultural broker or literacy guardian during communication in the ICU setting where care is especially complex, good communication is vital, and decision making is challenging.
Collapse
Affiliation(s)
| | - Meritxell Urtecho
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Samira Jubran
- Language Services, Mayo Clinic, Rochester, Minnesota, USA.
| | - Mei-Ean Yeow
- Center For Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Michael E Wilson
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research Unit (KER), Mayo Clinic, Rochester, Minnesota, USA.
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA; Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
12
|
Banse C, Owusu-Boakye S, Schade F, Jansky M, Marx G, Nauck F. [Can migration background be a boundary in palliative care at the end of life?]. Dtsch Med Wochenschr 2020; 146:e22-e28. [PMID: 33202430 PMCID: PMC7886499 DOI: 10.1055/a-1263-3437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hintergrund
Menschen mit Migrationshintergrund nutzen nach dem Stand der Forschung das palliative Versorgungsangebot wenig. Die möglichen Gründe sind weitgehend unklar. Häufig werden kulturelle Unterschiede geltend gemacht. Eine Untersuchung der Bedürfnisse von krebskranken Patienten mit Migrationshintergrund, ihren Angehörigen und medizinischen und pflegenden Versorgenden in Deutschland bietet einen Überblick über die Versorgungsprobleme.
Methoden
In dem qualitativen Forschungsdesign stehen biografische Erzählungen der Patienten, ihrer Angehörigen und der medizinischen und pflegenden Versorgenden im Vordergrund. Mit der Grounded Theory wurde eine Zeile-für-Zeile-Analyse der Daten durchgeführt, mit der verschiedene Kategorien und Handlungsstrategien im Umgang mit der Krankheit und der Versorgungssituation gefunden werden konnten.
Ergebnisse
Wenn schwerkranke Patienten mit Migrationshintergrund in einer palliativen Versorgungsstruktur ankommen, erleben sie in dieser politische und soziale Abgrenzungen. Migrationsspezifische Einflüsse erschweren deshalb die Bearbeitung der Krankheit und die palliativmedizinische Behandlung und Versorgung am Lebensende. Angehörige und medizinische und pflegende Versorgende erleben die Situation als eine Herausforderung, weil sie den Erwartungen der Patienten nicht entsprechen können und auf Übersetzer und Vermittler angewiesen sind. Viele Probleme werden kulturellen Unterschieden zugerechnet, obwohl die Patienten am Lebensende eher allgemeine Bedürfnisse formulieren.
Schlussfolgerung
Die Palliativversorgung von Menschen mit Migrationshintergrund findet häufig ohne spezifische Kenntnisse der Migrationsbiografie statt. Um den politischen und sozialen Einflüssen gerecht zu werden, bedarf es einer Unterstützung, die die Migrationsbiografie berücksichtigt.
Collapse
Affiliation(s)
| | - Sonja Owusu-Boakye
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen.,Department Pflege und Management, Hochschule für Angewandte Wissenschaften Hamburg
| | | | | | - Gabriella Marx
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen.,Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf
| | | |
Collapse
|
13
|
Torensma M, Suurmond JL, van der Heide A, Onwuteaka-Philipsen BD. Care and Decision-Making at the End of Life for Patients With a Non-Western Migration Background Living in The Netherlands: A Nationwide Mortality Follow-Back Study. J Pain Symptom Manage 2020; 59:990-1000.e5. [PMID: 31837456 DOI: 10.1016/j.jpainsymman.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 12/30/2022]
Abstract
CONTEXT Migrant populations across Europe are aging and will increasingly need end-of-life care. OBJECTIVE The objectives of this study were to gain insight into end-of-life care and decision-making for patients with a non-western migration background and assess differences compared to patients with a Dutch or western migration background. METHODS A mortality follow-back study was conducted using a stratified sample of death certificates of persons who died between August and December 2015, obtained from the central death registry of Statistics Netherlands. Questionnaires were sent to the attending physician (n = 9351; response 78%). Patients aged ≥18 years who died a nonsudden death were included in this study (n = 5327). RESULTS Patients with a non-western migration background are more likely than patients with a Dutch or western migration background to be admitted to and die in hospital (51.6% vs. 33.9% [OR 1.74; 95% CI 1.26-2.41]; 39.1% vs. 20.1% [OR 1.96; 95% CI 1.39-2.78]); less likely to receive morphine or morphine-like medication and continuous deep sedation (72.8% vs. 80.1% [OR 0.62; 95% CI 0.43-0.89]; 16.8% vs. 25.2% [OR 0.52; 95% CI 0.34-0.80]); and more likely to receive end-of-life care that, according to physicians, is directed at curation for too long (6.8% vs. 1.7% [OR 3.61; 95% CI 1.83-7.12]). End-of-life decisions are made less frequently for patients with a non-western migration background (71.6% vs. 79.2% [OR 0.64; 95% CI 0.45-0.91]). Characteristics of decision-making are similar. CONCLUSION End-of-life care for patients with a non-western migration background focuses more, or longer on maximum, curative treatment and end-of-life decisions are made less often.
Collapse
Affiliation(s)
- Marieke Torensma
- Department of Public Health, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jeanine L Suurmond
- Department of Public Health, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC Expertise center for Palliative Care and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Jansky M, Owusu-Boakye S, Nauck F. "An odyssey without receiving proper care" - experts' views on palliative care provision for patients with migration background in Germany. BMC Palliat Care 2019; 18:8. [PMID: 30665379 PMCID: PMC6341678 DOI: 10.1186/s12904-019-0392-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Background Migrants seem to be underrepresented in palliative care in Germany. Access barriers and challenges in care remain unclear. We aimed to provide a comprehensive insight into palliative care for migrants, using expert interviews. Methods Interviews with experts on palliative and general health care for migrants were audiotaped and transcribed. Data analysis followed a qualitative content analysis method for expert interviews proposed by Meuser and Nagel. Results In total, 13 experts from various fields (palliative and hospice care, other care, research and training) were interviewed. Experts identified access barriers on the health care system and the patient level as well as the sociopolitical level. Services don’t address migrants, who may use parallel structures. Patients may distrust the health care system, be oriented towards their home country and expect the family to care for them. In care, poor adaptation and inflexibility of health care services regarding needs of migrant patients because of scarce resources, patients’ preferences which may contradict professionals' values, and communication both on the verbal and nonverbal level were identified as the main challenges. Conflicts between patients, families and professionals are at risk to be interpreted exclusively as cultural conflicts. Palliative care providers should use skilled interpreters instead of family interpreters or unskilled staff members, and focus on training cultural competence. Furthermore, intercultural teams could enhance palliative care provision for migrants. Conclusions Though needs and wishes of migrant patients are often found to be similar to those of non-migrant patients, there are migration-specific aspects that can influence care provision at the end of life. Migration should be regarded as a biographical experience that has a severe and ongoing impact on the life of an individual and their family. Language barriers have to be considered, especially regarding patients' right to informed decision making. The reimbursement of interpreters in health care remains an open question. Electronic supplementary material The online version of this article (10.1186/s12904-019-0392-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany.
| | - Sonja Owusu-Boakye
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Goettingen, Robert Koch-Str. 40, 37075, Goettingen, Germany
| |
Collapse
|
15
|
Henke O, Thuss-patience P, Mauter D, Behzadi A. Bedürfnisse von Patienten mit Migrationshintergrund am Lebensende: Ergebnisse einer Befragung von ostasiatischen Palliativ- und Hospizpatienten und ihren Angehörigen zu transkultureller Pflegeerfahrung in Berlin. ACTA ACUST UNITED AC 2018; 9:66-76. [DOI: 10.1007/s16024-018-0318-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|