Vroegtijdige zorgplanning bij ouderen van Marokkaanse afkomst in België: Vergelijking van niet-palliatieve en palliatieve ouderen adhv interviewstudies

Abstract

Context. Advance care planning (ACP) is an important continuous process of dialogue between patients, their relatives and health care providers, which seeks to explore, clarify and document the values and care objectives most dear to the patient towards the end of life (EOL). It’s been shown to have several benefits for patient, family members and care professionals. For over half a century Belgium has known a considerable influx of Moroccan immigrants, the first generation of whom is now steadily aging and increasingly in need of appropriate EOL care. ACP engagement among these elders is however low and poorly studied.
Objectives. To explore the knowledge, attitudes, facilitators and barriers towards ACP among palliative elderly individuals of Moroccan origin and to compare these findings with findings from non-palliative elderly Moroccans.
Methods. This exploratoy qualitative study was based on a total of 32 semistructured interviews with elderly persons of Moroccan origin living in Belgium (age ≥ 65 years) using one same interview topic guide. Twenty-two were conducted among non-pallitiave and ten among palliative elderly individuals, as identified with the palliative care indicator tool (PICT).
Verbatim translations were analyzed in NVIVO using a constant comparative method.
Results. Important similarities between non-palliative (PICT-negative) and palliative (PICT-positive) participants were a general lack of knowledge of ACP and limited communication about health concerns and future care. In both groups respondents had however unwittingly engaged in certain ACP behaviors either alone or with relatives, mainly concerning talks about repatriation after death, burial and moving to a nursing home. Additionally among palliative respondents nearly have had remarried in order to ensure future care. Upon receiving clear and basic information about ACP most non-palliative patients expressed their willingness to talk about ACP topics not only with family members but also with their GP. Palliative participants were more ambiguous and expressed reluctance to have ACP formalized in written documents. Commonly mentioned barriers to higher ACP uptake among both groups were lack of knowledge about ACP, lack of initiative by their GP, even the Moroccan ones, and intense reliance on family for future care and decision making. Other barriers were the desire to avoid strife among and not to cause sorrow to family members and a perception of absence of a need for medical care. One barrier mentioned only by palliative patients was financial hardship. As for preferences non-palliative interviewees seemed to be more open to the idea of moving to a nursing home than palliative participants.
Conclusion. Both palliative and non-palliative older adults of Moroccan origin in Belgium are unaware of ACP. Health authorities and care professionals should provide information that is tailored and culture and religion sensitive. This should be initiated before individuals attain palliative status, when willingness to engage in ACP is seemingly still higher. GPs should be encouraged more to raise awareness and to initiate EOL and ACP talks. Campaigns and interventions to raise awareness and uptake should also target close relatives of these elders and take into account the family-centered models of decision making prevalent within Moroccan tradition that become more dominant as EOL approaches.

Date of Award	2022
Original language	Dutch
Awarding Institution	Interuniversitair Samenwerkingsverband HuisartsenOpleiding (ICHO)
Supervisor	Stéphanie De Maesschalck (Promotor) & Hakki Demirkapu (Co-promotor)