Thinking ahead in advanced illness: Exploring clinicians’ perspectives on discussing resuscitation with patients and families from ethnic minority communities

Article Figures & Data

Table 1.

Profession of respondents to interviews

Specialty	Registrar/ST3+, n=7	Consultant, n=8	General practitioner, n=5	Nurse, n=12
Elderly care	1	0	0	0
Oncology	0	0	0	1
Renal	0	2	0	3
Primary care	0	0	5	0
Palliative care	0	2	0	6
Haematology	0	2	0	0
Intensive care	1	1	0	0
Cardiology	0	0	0	2
General medicine	4	0	0	0
Surgery	1	0	0	0
Old age psychiatry	0	1	0	0

Table 2.

Themes of generic and additional ethnic minority-specific barriers

Barriers/facilitators to end-of-life care planning	Patient and family	Healthcare professional
Generic/universal	Religious reasoning (sanctity of life and death)
Ethnicity specific	Individual autonomy / family culture Language and communication	Cultural intelligence Spiritual and cultural support

Summary

What is known?

People from ethnic minority groups engage in advance care planning less frequently.
Healthcare professionals (HCPs) in the UK report a lack of confidence, knowledge and skills in providing culturally sensitive end-of-life care for ethnic minority patients.

What is the question?

What are the key barriers and enablers for HCPs discussing resuscitation with patients and families from ethnic minority groups?

What was found?

HCPs find conversations about deterioration and resuscitation challenging generally. Additional factors related to communication, religion and family increases this complexity when the patient is from an ethnic minority group.
HCPs felt more confident in having DNACPR discussions when they had existing knowledge about the patients’ religious, spiritual and cultural values and their confidence in initiating these conversations was developed through experience.
Envisaged ‘solutions’ for working in such uncertainty and emotionally challenging scenarios are often to increase confidence through factual ‘knowledge’. However, HCPs in this study sought to access reflective support, sharing of practices with colleagues and learning though simulated scenarios.

What are the implications for practice now?

Future training needs to create opportunities for HCPs to share experiences of ‘best practice’, as well as recognise unintentional and unacknowledged biases, anxieties and prejudices about other cultural values and beliefs.