The John A. Hartford Foundation Center of Excellence in Geriatrics, Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (LO, KM, CB).
University of Arkansas for Medical Sciences, Northwest Arkansas Campus, Fayetteville, AR (SK).
Hawaii J Health Soc Welf. 2020 Jun 1;79(6 Suppl 2):82-88.
Little is known about Marshallese palliative care practices. We explored traditional and contemporary Marshallese palliative care practices and examined generational differences. We performed three focus groups in 2011-2012 among Marshall Islanders in Hawai'i. A native speaking interpreter assisted group facilitators. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices, the effect of economic and social challenges in Hawai'i, and generational differences comparing young and old. Nineteen persons (10 men and 9 women, youth aged 17-27 years, and elders as defined in Marshallese culture, aged 46-79) participated. A "good death" was defined as "peaceful and pain free," occurring from natural causes. Factors associated with a "good death" included gathering of family to absolve conflicts, and proper and timely cultural practices. Factors associated with "bad deaths" included young age, active suffering, accidents, suicides, "black magic/curses," or lack of timely or proper burial. Comparing generational differences, older Marshallese had differing opinions regarding preferred place of death, burial site, cultural practice preservation, artificial prolongation of life, and cremation. Barriers included mortuary fees, cost of transporting bodies, United States (US) government policies, and wait times for death certificates. Many cultural factors contribute to "good" or "bad" deaths. Attitudes toward palliative care practices differ by generation. Having previously documented different approaches by Yapese, a generalized "one size fits all" approach to Micronesians is inappropriate. Overcoming identified barriers may facilitate practices necessary for a good death in Micronesian populations in their home nations and as they migrate to communities throughout the US.
人们对马绍尔群岛的姑息治疗做法知之甚少。我们探讨了传统和当代马绍尔群岛的姑息治疗做法，并考察了代际差异。2011-2012 年，我们在夏威夷的马绍尔群岛人中进行了三次焦点小组讨论。一位以母语为英语的口译员协助小组主持人。使用经典主题三角分析方法对数据进行分析，以确定特定的马绍尔群岛姑息治疗做法、夏威夷的经济和社会挑战的影响，以及比较年轻人和老年人的代际差异。19 人（10 名男性和 9 名女性，年龄在 17-27 岁的年轻人和马绍尔文化中定义的老年人，年龄在 46-79 岁）参加了讨论。“善终”被定义为“平静无痛苦”，由自然原因引起。与“善终”相关的因素包括家庭团聚以消除冲突，以及适当和及时的文化习俗。与“恶终”相关的因素包括年轻、痛苦、事故、自杀、“黑魔法/诅咒”或缺乏及时或适当的埋葬。比较代际差异，年长的马绍尔人对理想的死亡地点、埋葬地点、文化习俗的保存、人工延长生命和火化有不同的看法。障碍包括太平间费用、运送遗体的费用、美国政府政策以及死亡证明的等待时间。许多文化因素导致了“好”或“坏”的死亡。对姑息治疗做法的态度因代际而异。 Yapese 之前已经记录了不同的方法，对密克罗尼西亚人采用一种普遍的“一刀切”的方法是不恰当的。克服已确定的障碍可能有助于密克罗尼西亚人在其祖国和移居美国各地的社区中实现善终所需的做法。
