A confluence of cultures: advance care planning in long-term care settings

Soheilipour, Shimae, Jang, Katrina, de Vries, Brian, Kwan, Helen and Gutman, Gloria (2023) A confluence of cultures: advance care planning in long-term care settings. Journal of Long-Term Care. pp. 120-134. ISSN 2516-9122

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Abstract

Context: While policies may promote Advance Care Planning (ACP) discussions in long-term care (LTC) settings, practices often result in outcomes different from residents’ wishes. We attribute this to a confluence of cultures: healthcare; LTC settings; mainstream societal; and individuals’ ethno-cultures. This research explores these cultures as reflected in focus group discussions conducted with residents and family-of-residents in two LTC homes: one exclusively Chinese (EC); one multicultural (MC). Method: Fourteen residents and 13 family members participated in the four focus groups. Discussions were audio-recorded, transcribed, and themes were extracted and compared. Results: Four themes characterized residents’ discussions: 1-Variations in Range/Type of ACP Discussions/Actions; 2-Care of Family; 3-Reliance on Staff; and 4-Quality-of-Life at End-of-Life. Exclusively Chinese residents expressed reluctance to speak about ACP, were more likely to state “family would handle it,” less likely to call upon staff, and more acquiescent concerning death. Multicultural residents were more likely to pejoratively mention pull or absence of family and reliance upon staff; also, wanting personal awareness and control at end-of-life. Family themes were 1-Timing/Focus of ACP Discussions, 2-Communication with Family, 3-Care Home and Staff Influences, and 4-Cultural and Religious Issues. Exclusively Chinese families spoke of need to involve family in ACP discussions inclusive of residents and of Chinese cultural influences on ACP. Multicultural families reported being “taken by surprise” and feeling “overwhelmed” by requests to engage in ACP and document completion on behalf of residents. Conclusion: Findings provide evidence of multiple cultural influences on ACP in LTC but existing institutional policies and practices offer little direction and support on how to balance/prioritize them. Our analyses may provide a starting point.

Item Type:	Article
Additional Information:	© 2023 The Author(s)
Divisions:	LSE
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited:	03 Oct 2023 10:30
Last Modified:	12 Dec 2024 03:53
URI:	http://eprints.lse.ac.uk/id/eprint/120349

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