Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

Abstract

BackgroundUnderstanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices.MethodsA volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology.ResultsThe mean age of the females in the sample was 30.3 years (range, 19–55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity), “whole person” (higher religiosity), “pain and informational privacy concerned” (lower life quality), “decisional privacy concerned” (older, higher life quality), and “life quantity concerned, family dependent” (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%–50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample.ConclusionConsistent with the previously reported findings in Saudi males, transcendence and dying in the hospital were the extreme end-of-life priority and dis-priority, respectively, in Saudi females. Body modesty was a major overall concern; however, concerns about pain, various types of privacy, and life quantity were variably emphasized by the five opinion-based groups but masked by averaging analysis.

<p>Modeling Lay People’s Ethical Attitudes to Organ Donation: A Q-Methodology Study</p>

“…Finally, one advantage of Q-methodology is its tendency to avoid the depersonalization of averaging-analysis. [50][51][52][53] This was obvious in this study. Out of the 23 statements that received neutral ranks on averaging-analysis, 48-65% received extreme ranks in one or more of the women and men models, and out of the 14 statements with extreme ranks in a women or men model, 14-64% received neutral ranks on averaging-analysis.…”

“…Q-methodology has been used to overcome such limitations. [50][51][52][53] A type of by-person factor analysis, Q-methodology uses forced-ranking of opinion statements to produce grouping of respondents based on their thinking patterns. 54 The aim of this study was to explore how lay people invoke and balance the four ethical principles of principlism and whether they use other principles to achieve ethical resolution in relation to organ donation.…”

Factors underlying surrogate medical decision-making in middle eastern and east Asian women: a Q-methodology study

“…End-of-life preferences may be culture and sex [21,22,43] as well as religiosity [23] dependent. We observed two notable differences between ME and EA respondents.…”

“…End-of-life priorities [21,22] and factors underlying surrogate decision-making may be culture-dependent; religiosity and social outlook (on liberal-conservative continuum) contributed to the variance in physicians' attitude toward end-of-life decision-making, [23] and while 85% of the US public expressed desire to be informed if they had < 1 year to live, only 49% of Japanese did [17].…”

“…Study designs that use independent rating and score-averaging do not provide insight on relative importance [ 31 ] and may obscure individual priority structures, respectively [ 21 , 22 ] In Q-methodology, a forced-ranking study design followed by factor analysis, respondents model their point of view by rank-ordering opinion statements along a fixed continuum of symmetrical distribution [ 32 ]. Q-methodology allows assessment of individual priority structures as well as grouping of similar-minded individuals [ 33 ].…”