Pernilla Ågård

The ‘Other’ in End-of-life Care: Providers’ Understandings of Patients with Migrant Backgrounds

ABSTRACT Research on how end-of-life care providers make sense of cultural, ethnic and religious diversity is relatively scarce. This article explores end-of-life care providers’ understandings of patients with migrant backgrounds through a study based on focus group interviews. The analysis brings to the fore three themes: the expectation that the existence of difference and uncertainty is a given when caring for patients with migrant backgrounds; the expectation that the extension of responsibility that difference entails creates a variety of dilemmas; and the expectation that difference will bring about misunderstandings and that patients’ needs can go unmet as a result of this. On the basis of these themes we suggest that the end-of-life care providers interviewed regard patients with migrant backgrounds as ‘Others’ and themselves as providers that cannot deliver so called culture-competent care. The findings are problematised using the lens that the debate on patient-centredness offers. The article suggests that if the uniqueness of all patients is to be seriously taken into account then ‘Othering’ is perhaps what patient-centredness actually entails.

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

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