Torensma Marieke, de Voogd Xanthe, Oueslati Roukayya, van Valkengoed Irene G M, Willems Dick L, Onwuteaka-Philipsen Bregje D, Suurmond Jeanine L
Amsterdam UMC, University of Amsterdam, Department of Public and Occupational Health; Amsterdam Public Health Research Institute; Amsterdam UMC Expertise center for Palliative Care, Meibergdreef 9, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Ethics, Law and Humanities, De Boelelaan 1089a, Amsterdam, the Netherlands.
J Migr Health. 2024 Dec 23;11:100293. doi: 10.1016/j.jmh.2024.100293. eCollection 2025.
As migrant populations age, the care system is confronted with the question how to respond to care needs of an increasingly diverse population of older adults. We used qualitative intersectional analysis to examine differential preferences and experiences with care at the end of life of twenty-five patients and their relatives from Suriname, Morocco and Turkey living in The Netherlands. Our analysis focused on the question how - in light of impairment - ethnicity, religion and gender intersect to create differences in social position that shape preferences and experiences related to three main themes: place of care at the end of life; discussing prognosis, advance care, and end-of-life care; and, end-of-life decision-making. Our findings show that belonging to an ethnic or religious minority brings forth concerns about responsive care. In the nursing home, patients' minority position and the interplay thereof with gender make it difficult for female patients to request and receive responsive care. Patients with a strong religious affiliation prefer to discuss diagnosis but not prognosis. These preferences are at interplay with factors related to socioeconomic status. The oversight of this variance hampers responsive care for patients and relatives. Preferences for discussion of medical aspects of care are subject to functional impairment and faith. Personal values and goals often remain unexpressed. Lastly, preferences regarding medical end-of-life decisions are foremost subject to religious affiliation and associated moral values. Respondents' impairment and limited Dutch language proficiency requires their children to be involved in decision-making. Intersecting gendered care roles determine that mostly daughters are involved. Considering the interplay of aspects of social identity and their effect on social positioning, and pro-active enquiry into values, goals and preferences for end-of-life care of patients and their relatives are paramount to achieve person centred and family-oriented care responsive to the needs of diverse communities.
随着移民人口老龄化，医疗体系面临着如何应对日益多样化的老年人群护理需求的问题。我们运用定性交叉性分析方法，研究了居住在荷兰的25名来自苏里南、摩洛哥和土耳其的患者及其亲属在临终护理方面的不同偏好和经历。我们的分析聚焦于这样一个问题：鉴于身体机能受损，种族、宗教和性别如何相互交织，造成社会地位差异，从而塑造与三个主要主题相关的偏好和经历，这三个主题分别是：临终护理地点；讨论预后、预立医疗照护及临终护理；以及临终决策。我们的研究结果表明，属于少数族裔或宗教群体引发了对响应性护理的担忧。在养老院中，患者的少数群体地位及其与性别的相互作用，使得女性患者难以请求并获得响应性护理。宗教信仰强烈的患者更倾向于讨论诊断结果而非预后。这些偏好与社会经济地位相关因素相互作用。对这种差异的忽视妨碍了对患者及其亲属的响应性护理。对护理医疗方面进行讨论的偏好受身体机能受损情况和信仰的影响。个人价值观和目标往往未得到表达。最后，关于医疗临终决策的偏好主要受宗教信仰及相关道德价值观的影响。受访者身体机能受损且荷兰语水平有限，这就需要他们的子女参与决策。交叉性别的护理角色决定了主要是女儿参与其中。考虑到社会身份各方面的相互作用及其对社会定位的影响，积极探究患者及其亲属对临终护理的价值观、目标和偏好，对于实现以患者为中心、以家庭为导向、响应不同社区需求的护理至关重要。
