Culture and End of Life Care: A Scoping Exercise in Seven European Countries

Abstract

Aim Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries. Methods We scoped the literature for Germany, Norway, Belgium, the Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes. Results A total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities. Conclusion This scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.

Medical Residents’ Practices and Perceptions toward Do-Not-Resuscitate (DNR) Order

“…Some believed that diagnostic tests shouldn't be ordered when a patient was DNR [2]. One Study surveyed primary and cross-covering residents of patients with DNR orders and found that residents intended to withhold a variety of other therapeutic interventions, that in half of these instances there was no chart documentation to that effect, and that there was little agreement between primary and cross-covering residents regarding which therapies to withhold [11,12]. It must be emphasized that a decision to withhold CPR means only that death accepted when it occurred with no implications for all other aspects of care for the patient.…”

End of life care in high-grade glioma patients in three European countries: a comparative study

“…Nonetheless, the actual place of death is often not in line with patient's preferences, especially in the UK and Austria where most patients die in a hospice or hospital, respectively. The various health care strategies towards the EOL probably underlie this difference [12,30]. In the UK, hospices are considered a valuable alternative to care at home at the EOL.…”

“…In general, the organization of EOL care within the existing health care system differs widely between countries, due to cultural-historical differences in attitudes towards the EOL and related care [12]. Aspects related to the organization of EOL care for HGG, patient's preferences, and actual provided care in the EOL are also expected to differ between countries, and may subsequently influence the perceived quality of care (QOC).…”

Preferences regarding disclosure of prognosis and end-of-life care: A survey of cancer patients with advanced disease in a lower-middle-income country

“…6 However, other research suggests that there are meaningful variations in approaches to end-of-life (EOL) in different cultural contexts. [7][8][9][10][11] Some authors have argued that Muslim patients living in Muslim majority countries may have preferences regarding EOL care that are informed by key Islamic values. 12,13 Palliative and EOL care services in many low-and middle-income countries (LMIC) are still at a nascent stage and more work is needed to understand the preferences of patients in these countries regarding EOL care.…”