Advance care planning among older adults in Belgium with Turkish backgrounds and palliative care needs: A qualitative interview study

Data on advance care planning (ACP) among migrants in Europe is lacking. Research has shown that few older migrants in the United States perform ACP due to healthcare system distrust, collectivistic values and spirituality/religion. To explore the ACP knowledge and perspectives of older Turkish-origin adults in Belgium requiring palliative care. General practitioners (GPs) in Brussels and Antwerp recruited Turkish-origin participants aged ≥ 65 years with palliative care eligibility for this qualitative study. A GP conducted semi-structured interviews in Turkish in respondents’ homes between May 2019 and February 2022 using a topic guide. Two researchers performed combined inductive/deductive thematic data analysis. All 15 interviewees (average age, 79 years) lacked ACP awareness and information. Some had discussed specific end-of-life preferences (e.g. care location, burial place) with family. Still, many did not feel the need to discuss future healthcare preferences, due mainly to trust in God and family for caretaking and decision-making. Some respondents viewed ACP discussions as applicable, relieving the burden on family and enabling proactive addressing of ‘what if’ questions. Self-identified ACP barriers were fear of making wrong decisions, ‘living in the moment’ and difficulty discussing death. Facilitators were obtaining sufficient ACP information and recent family illness or death. Our sample of Turkish-origin older adults in Belgium requiring palliative care lacked ACP knowledge. Our findings suggest that their lack of engagement in discussing end-of-life medical care planning was linked to their family dynamics and religion. The findings have implications for healthcare providers to ethnic-minority groups.

欧洲移民的预先医疗照护（advance care planning, ACP）相关数据仍较为匮乏。已有研究显示，美国的老年移民因对医疗体系缺乏信任、秉持集体主义价值观以及受精神/宗教信仰影响，较少开展预先医疗照护规划。本研究旨在探究比利时境内、需要姑息治疗（palliative care）的土耳其裔老年群体对预先医疗照护的认知与态度。本项质性研究由布鲁塞尔与安特卫普的全科医师（General Practitioners, GPs）招募符合姑息治疗指征、年龄≥65岁的土耳其裔参与者。2019年5月至2022年2月期间，一名全科医师采用半结构化访谈提纲，以土耳其语在受访者家中开展访谈。两名研究者采用归纳与演绎结合的主题分析法对数据进行分析。全部15名受访者（平均年龄79岁）均缺乏预先医疗照护相关认知与信息。部分受访者曾与家属讨论过具体的临终偏好，例如照护地点、安葬场所，但仍有多数受访者认为无需讨论未来的医疗照护偏好，这主要源于他们对上帝及家庭照护与决策的信任。部分受访者认为预先医疗照护讨论具有必要性，可减轻家庭负担，并能主动应对“假设性”医疗场景问题。受访者自述的预先医疗照护阻碍因素包括：害怕做出错误决策、“活在当下”的心态，以及难以谈论死亡相关话题；促进因素则包括获取充足的预先医疗照护信息，以及近期遭遇家庭成员患病或离世。本研究样本——比利时境内需要姑息治疗的土耳其裔老年群体——普遍缺乏预先医疗照护相关知识。研究结果表明，该群体较少参与临终医疗照护规划讨论，与其家庭互动模式及宗教信仰存在关联。上述发现可为面向少数族裔群体的医疗服务提供者提供参考。