Fang Mei Lan, Sixsmith Judith, Sinclair Shane, Horst Glen
Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC, V6B 5 K3, Canada.
Institute of Health and Wellbeing, University of Northampton, Northampton, UK.
BMC Geriatr. 2016 May 18;16:107. doi: 10.1186/s12877-016-0282-6.
Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool.
To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June-August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004-2014.
The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making.
This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.
多种因素影响临终关怀以及文化和精神多元群体对劣质服务的体验。与欧洲白人群体相比，少数族裔难以获得临终关怀服务，例如家庭或临终关怀机构的健康和社会支持。需要一种工具来帮助患者及其家人获得文化上安全的护理。加拿大虚拟临终关怀组织开展了这项综述，作为开发此工具的基础。
为了探究文化和精神多元群体对临终关怀的态度、行为和使用模式，并确定临终关怀实践和提供方式中的差距，对文章内容进行了范围综述和主题分析。2014年6月至8月期间，检索了14个电子数据库和网站，以识别2004年至2014年期间发表的英文同行评审出版物和灰色文献（包括报告和其他在线资源）。
检索发现了系统、社区和个人/家庭层面的障碍和促进因素。主要障碍包括：医疗服务提供者与临终者及其家庭成员之间的文化差异；旨在改善临终关怀的文化敏感模式利用不足；语言障碍；对文化和宗教多样性问题缺乏认识；在决策过程中排斥家庭；个人的种族和宗教歧视；以及缺乏针对不同文化的临终信息以促进决策。
本综述强调，大多数研究都集中在决策方面。探索临终时不同文化和精神体验以及改善临终关怀干预措施的研究较少。所评估的干预措施在很大程度上是教育性质的，而非服务导向型的。
