Journal Article

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

Gibb, Maya, Cody, Margaret, Karunananthan, Sathya, Lee, Seung Heyck, Bédard, Daniel, Kehoe MacLeod, Krystal, Kendall, Claire E., Collin, Stephanie, Tanuseputro, Peter

2024

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Chronic illnesses / Communication Barriers / Cultural competence / Cultural competency / Culture / Data collection / Decision making / Discordance / Emergency medical care / Equality and Human Rights / Family medicine / Family physicians / Female / Geography / Health aspects / Health care access / Health Policy / Health Promotion and Disease Prevention / Health Services Accessibility / Health Services Research / Humans / Interpreters / Intersectionality / Interviews / Interviews as Topic / Language / Linguistics / Long-term care / Long-term care of the sick / Male / Medicine / Medicine & Public Health / Middle Aged / Minorities / Minority & ethnic groups / Ontario / Palliation / Palliative care / Palliative Care - psychology / Palliative Care - standards / Palliative medicine / Palliative treatment / Patients / Physician-Patient Relations / Physicians / Physicians - psychology / Practice / Primary care / Psychological aspects / Public Health / Qualitative Research / Rural areas / Social aspects / Social Justice / Social Policy / Terminal Care - psychology / Terminal Care - standards / Verbal communication / Wages & salaries