Advance care planning among older adults in Belgium with Turkish backgrounds and palliative care needs: A qualitative interview study

BACKGROUND

Data on advance care planning (ACP) among migrants in Europe is lacking. Research has shown that few older migrants in the United States perform ACP due to healthcare system distrust, collectivistic values and spirituality/religion.

OBJECTIVES

To explore the ACP knowledge and perspectives of older Turkish-origin adults in Belgium requiring palliative care.

METHOD

General practitioners (GPs) in Brussels and Antwerp recruited Turkish-origin participants aged ≥ 65 years with palliative care eligibility for this qualitative study. A GP conducted semi-structured interviews in Turkish in respondents' homes between May 2019 and February 2022 using a topic guide. Two researchers performed combined inductive/deductive thematic data analysis.

RESULTS

All 15 interviewees (average age, 79 years) lacked ACP awareness and information. Some had discussed specific end-of-life preferences (e.g. care location, burial place) with family. Still, many did not feel the need to discuss future healthcare preferences, due mainly to trust in God and family for caretaking and decision-making. Some respondents viewed ACP discussions as applicable, relieving the burden on family and enabling proactive addressing of 'what if' questions. Self-identified ACP barriers were fear of making wrong decisions, 'living in the moment' and difficulty discussing death. Facilitators were obtaining sufficient ACP information and recent family illness or death.

CONCLUSION

Our sample of Turkish-origin older adults in Belgium requiring palliative care lacked ACP knowledge. Our findings suggest that their lack of engagement in discussing end-of-life medical care planning was linked to their family dynamics and religion. The findings have implications for healthcare providers to ethnic-minority groups.

Advance Care Planning Among Older Adults of Turkish Origin in Belgium: Exploratory Interview Study

CONTEXT

Although conversations about future medical treatment and end-of-life care are considered to be important, ethnic minorities are much less engaged in advance care planning (ACP).

OBJECTIVES

To explore ACP knowledge, experiences, views, facilitators, and barriers among older adults of Turkish origin in Belgium.

METHODS

This qualitative study was based on constant comparative analysis of semistructured interview content. Participants were 33 older adults (aged 65-84 years; mean, 71.7 years; median, 74.5 years) of Turkish origin living in Belgium.

RESULTS

Despite unfamiliarity with the term ACP in this sample, several participants had engaged in some ACP behaviors. Respondents considered ACP to be useful and were ready to engage in conversations about it. The most commonly mentioned facilitator was the provision of tailored information about ACP. Other facilitators included concerns about future care needs, increasing awareness among respondents' children about the advantages of ACP, and respondents' desire to avoid "burdening" their children. The most commonly mentioned barrier was respondents' lack of knowledge about ACP. Other barriers were language issues, a lack of urgency about ACP discussion, reliance on familial support, and older adults' fear of triggering negative emotions in themselves and their children.

CONCLUSIONS

The provision of tailored information about ACP to older adults of Turkish origin in Belgium and the promotion of awareness about the importance of ACP among their children (when patients desire), as well as the use of professional interpreters, could facilitate ACP engagement in this population.