Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework
Abstract Background Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care mod...
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BMC
2024-11-01
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| Series: | International Journal for Equity in Health |
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| Online Access: | https://doi.org/10.1186/s12939-024-02312-2 |
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| author | Seung Heyck Lee Maya Gibb Sathya Karunananthan Margaret Cody Peter Tanuseputro Claire E. Kendall Daniel Bédard Stephanie Collin Krystal Kehoe MacLeod |
| author_facet | Seung Heyck Lee Maya Gibb Sathya Karunananthan Margaret Cody Peter Tanuseputro Claire E. Kendall Daniel Bédard Stephanie Collin Krystal Kehoe MacLeod |
| author_sort | Seung Heyck Lee |
| collection | DOAJ |
| description | Abstract Background Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians. Methods In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework. Results We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians’ lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments. Conclusion Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups. |
| format | Article |
| id | doaj-art-e4145dac394940178eec0f49b56225a3 |
| institution | DOAJ |
| issn | 1475-9276 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj-art-e4145dac394940178eec0f49b56225a32025-08-20T02:50:05ZengBMCInternational Journal for Equity in Health1475-92762024-11-0123111310.1186/s12939-024-02312-2Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy frameworkSeung Heyck Lee0Maya Gibb1Sathya Karunananthan2Margaret Cody3Peter Tanuseputro4Claire E. Kendall5Daniel Bédard6Stephanie Collin7Krystal Kehoe MacLeod8Faculty of Medicine, University of OttawaOttawa Hospital Research InstituteBruyère Research InstituteBruyère Research InstituteDepartment of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong KongFaculty of Medicine, University of OttawaInstitut du Savoir MontfortMoncton UniversitéFaculty of Medicine, University of OttawaAbstract Background Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians. Methods In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework. Results We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians’ lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments. Conclusion Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups.https://doi.org/10.1186/s12939-024-02312-2LanguageCultural competencyPalliative medicinePrimary careHealth policyQualitative research |
| spellingShingle | Seung Heyck Lee Maya Gibb Sathya Karunananthan Margaret Cody Peter Tanuseputro Claire E. Kendall Daniel Bédard Stephanie Collin Krystal Kehoe MacLeod Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework International Journal for Equity in Health Language Cultural competency Palliative medicine Primary care Health policy Qualitative research |
| title | Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework |
| title_full | Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework |
| title_fullStr | Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework |
| title_full_unstemmed | Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework |
| title_short | Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework |
| title_sort | lived experiences of palliative care physicians on the impacts of language and cultural discordance on end of life care across ontario canada a qualitative study using the intersectionality based policy framework |
| topic | Language Cultural competency Palliative medicine Primary care Health policy Qualitative research |
| url | https://doi.org/10.1186/s12939-024-02312-2 |
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