Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework

Seung Heyck Lee; Maya Gibb; Sathya Karunananthan; Margaret Cody; Peter Tanuseputro; Claire E Kendall; Daniel Bédard; Stephanie Collin; Krystal Kehoe MacLeod

doi:10.1186/s12939-024-02312-2

Lived experiences of palliative care physicians on the impacts of language and cultural discordance on end-of-life care across Ontario, Canada: a qualitative study using the intersectionality-based policy framework

Int J Equity Health. 2024 Nov 8;23(1):229. doi: 10.1186/s12939-024-02312-2.

Authors

Seung Heyck Lee¹, Maya Gibb², Sathya Karunananthan^{3

4}, Margaret Cody³, Peter Tanuseputro⁵, Claire E Kendall^{1

2

3

6}, Daniel Bédard⁶, Stephanie Collin⁷, Krystal Kehoe MacLeod^{8

9

10}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Ottawa Hospital Research Institute, Ottawa, ON, Canada.
³ Bruyère Research Institute, Ottawa, ON, Canada.
⁴ Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
⁵ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁶ Institut du Savoir Montfort, Ottawa, ON, Canada.
⁷ Moncton Université, Moncton, NB, Canada.
⁸ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. kmacleod@bruyere.org.
⁹ Ottawa Hospital Research Institute, Ottawa, ON, Canada. kmacleod@bruyere.org.
¹⁰ Bruyère Research Institute, Ottawa, ON, Canada. kmacleod@bruyere.org.

Abstract

Background: Language and cultural discordance refer to when a physician and patient do not share the same language or culture. This can create barriers to providing high-quality care at the end-of-life (EoL). This study explores the intersections of language, culture, geography, and care model in EoL care from the perspectives of palliative care physicians.

Methods: In this exploratory-descriptive qualitative study, semi-structured interviews (1-h) were conducted virtually between July and November 2023. We interviewed 16 family physicians with experience providing linguistic and/or culturally discordant palliative/EoL care in various urban, suburban, and rural regions of Ontario, who practiced at community and hospital outpatient clinics, home-based care, or long-term care homes. We used reflexive thematic analysis to identify themes across the interviews guided by the intersectionality theoretical framework.

Results: We identified three themes 1) Visible barriers to care access due to the inability to communicate accurate information and insufficient time spent during appointments with patients; 2) Invisible barriers to care access, shaped by the Eurocentric approach to palliative care and physicians' lack of awareness on cultural discordance; 3) Workplace supports that currently exist and interventions that physicians would like to see. Community physicians following fee-for-service models were less likely to have access to professional interpreter services. Physicians in long-term care emphasized resource limitations to providing culturally-appropriate care environments.

Conclusion: Cultural discordance required awareness of personal biases, while language discordance hindered basic communication. These findings will be useful in informing clinical practice guidelines and mobilizing policy-level change to improve palliative/EoL care for patients from linguistic and cultural minority groups.

Keywords: Antiracism; Cultural competency; Health policy; Language; Palliative medicine; Primary care; Qualitative research.

MeSH terms

Adult
Communication Barriers
Female
Health Services Accessibility
Humans
Interviews as Topic
Language
Male
Middle Aged
Ontario
Palliative Care* / psychology
Palliative Care* / standards
Physician-Patient Relations
Physicians / psychology
Qualitative Research*
Terminal Care* / psychology
Terminal Care* / standards