Living and dying between cultural traditions in African & Caribbean Heritage families: a constructivist grounded theory.

BACKGROUND: Ethnic differences influence end-of-life health behaviours and use of palliative care services. Use of formal Advance care planning is not common in minority ethnic heritage communities. Older adults expect and trust their children to be their decision makers at the end of life. The study aim was to construct a theory of the dynamics that underpin end-of-life conversations within families of African and Caribbean heritage. This is a voice not well represented in the current debate on improving end-of-life outcomes. METHODS: Using Charmaz's constructivist grounded theory approach, a purposive sample of elders, adult-children, and grandchildren of African and Caribbean Heritage were recruited. In-person and online focus groups were conducted and analysed using an inductive, reflexive comparative analysis process. Initial and axial coding facilitated the creation of categories, these categories were abstracted to constructs and used in theory construction. RESULTS: Elders (n = 4), adult-children (n = 14), and adult grandchildren (n = 3) took part in 5 focus groups. A grounded theory of living and dying between cultural traditions in African and Caribbean heritage families was created. The constructs are (a) Preparing for death but not for dying (b) Complexity in traditions crosses oceans (c) Living and dying between cultures and traditions (d) There is culture, gender and there is personality (e) Watching the death of another prompts conversations. (f) An experience of Hysteresis. DISCUSSION: African and Caribbean cultures celebrate preparation for after-death processes resulting in early exposure to and opportunities for discussion of these processes. Migration results in reforming of people's habitus/ world views shaped by a mixing of cultures. Being in different geographical places impacts generational learning-by-watching of the dying process and related decision making. CONCLUSIONS: Recognising the impact of migration on the roles of different family members and the exposure of those family members to previous dying experiences is important. This can provide a more empathetic and insightful approach to partnership working between health care professionals and patients and families of minority ethic heritage facing serious illness. A public health approach focusing on enabling adult-children to have better end of life conversations with their parents can inform the development of culturally competent palliative care.

Views, emotional Reaction, and Bereavement Healing Rituals of Saudi Male Nursing Students: A Qualitative Approach.

AIM: The study described the perception and attitude of Saudi male nursing students towards death and dying. METHODS: This qualitative study recruited Twelve male Saudi nursing students from Nursing Department at University, Riyadh, Saudi Arabia. Data collection was conducted using unstructured one-on-one online interviews from January to February 2021 using thematic approach to analyse the data. RESULTS: The result of the study presented three themes. The first theme describes the Muslim Saudi male nursing student's religious beliefs and practices in terms of three concepts. The second theme is the emotional reaction of the participants. The third theme is bereavement healing rituals. CONCLUSION: The knowledge on how nursing students with an Islamic belief view the concept of death and dying provides valuable and critical information on developing educational intervention as well as course and training contents that needs to be included in developing the competencies of these students.

Chinese medical teachers' cultural attitudes influence palliative care education: a qualitative study.

BACKGROUND: China holds one fifth of the world's population and faces a rapidly aging society. In its ambition to reach a health care standard comparable to developed countries by 2030, the implementation of palliative care gains special importance. Until now, palliative care education in China is limited and disparate. This study aims to explore and determine factors that have impeded the development and implementation of palliative care education in China. METHODS: We conducted semi-structured interviews with n=28 medical teachers from seven Chinese universities. Interviews were transcribed, and thematic analysis applied. RESULTS: Three themes with two subthemes were constructed from data analysis. Theme 1 covers the still ambivalent perception of palliative care and palliative care education among participants. The second theme is about cultural attitudes around death and communication. The third theme reflects participants' pragmatic general understanding of teaching. All themes incorporate obstacles to further implementation of palliative care and palliative care education in China. CONCLUSIONS: According to the study participants, palliative care implementation through palliative care education in China is hindered by cultural views of medical teachers, their perception of palliative care and palliative care education, and their understanding of teaching. The study demonstrates that current attitudes may work as an obstacle to the implementation of palliative care within the health care system. Approaches to changing medical teachers' views on palliative care and palliative care education and their cultural attitudes towards death and dying are crucial to further promote the implementation of palliative care in China.

Embracing Death: Mexican Parent and Child Perspectives on Death.

A mixed-method approach was used to explore parent and child perspectives on death in Mexico. Parents' and children's death-related experiences and understanding of death were examined. While all children in this sample displayed a biological understanding of death, older children were less likely to endorse that all living things die. Children also displayed coexistence of beliefs related to death that can be attributed to both their biological and spiritual understanding of death. We also found that older children were more likely to report that a child should feel sad following the death of a loved one. These findings highlight how cultural practices shape the development of cognitive and affective processes related to death.

Breast cancer stigma among Indonesian women: a case study of breast cancer patients.

BACKGROUND: The stigma experienced by cancer patients stems from the association of cancer with death, as cancer is the most feared disease worldwide, especially among cancer patients and their families. The stigma regarding breast cancer screening behaviour has not been critically evaluated and is poorly understood; therefore, we aimed to analyse the stigmatization of breast cancer patients in Indonesia to reduce the morbidity and mortality of breast cancer. METHODS: A qualitative study using a focus group discussion (FGD) and in-depth interviews with thematic analysis was conducted. RESULTS: One informant experienced breast pain and kept the referral letter, in which the medical doctor advised medical treatment, to herself for 3 months due to her embarrassment. A traditional healing practice known as 'kerokan', which involves scraping of the skin, and consumption of a traditional drink were used by most informants to decrease their breast pain. Finally, most informants were diagnosed with an advanced stage of cancer when they returned to the health care facility. In addition, financial difficulties were noted as barriers to breast cancer screening in Indonesia. CONCLUSIONS: Feelings of fear and shame when diagnosed with breast cancer were reported by the informants in this study. Alternative treatment known as 'kerokan' was the first treatment sought for breast cancer symptoms due to financial difficulties among breast cancer patients. Informants were diagnosed with an advanced stage of cancer after they returned to the health care facility. A better understanding of early breast cancer symptoms could motivate women to seek out breast cancer treatment.

Reincarnation beliefs among Israeli Druze and the construction of a hard primordial identity.

Most of the literature on reincarnation among the Druze attempts to shed light on its history and on those who believe in it. In this paper, we will argue that the Druze's belief in reincarnation serves as one of the central components in defining their ethno-religious identity. Our study is based on an analysis of 30 semi-structured interviews with Israeli Druze university students. Findings suggest that the belief in reincarnation plays an important role in the lives of the Druze and it appears to serve as the most outstanding component in the young Druze' definition of their primordial identity.

An expressive-arts-based life-death education program for the elderly: A qualitative study.

This study endeavors to investigate how healthcare workers, equipped with expressive arts methods, could foster life-death education for the elderly. Forty-nine older adults aged 60 or above joined a 10-session expressive arts-based life-death education program that was led by social workers equipped with expressive arts methods. An ethnographic research approach, with a post-treatment focus group (n = 17), was conducted with the participants. The results showed that expressive arts methods could enhance reorganization of life experiences, promote dealing with ambivalent emotion regarding life-death issues, improve communicating life-death issues with family members, and induce ideas to prepare for death.

Does the mortality salience effect on worldview defence depend on the cultural orientation of Chinese people?

According to the terror management theory, people tend to favour their worldview and in-group members after being reminded of death (i.e., mortality salience [MS] effect). However, inconsistent findings of the MS effect were found among Chinese people. In the present study, we examined the MS effect with Chinese samples and tested whether the effect would depend on participants' cultural orientation and relational self-esteem. In Studies 1 (N = 227) and 2 (N = 221), we examined the roles of participants' cultural orientations and relational self-esteem in their evaluations on moral transgression and/or perceived regard from people around after being primed with mortality (vs. dental pain) salience. We obtained the interaction effects of mortality salience, cultural orientations, and relational self-esteem. The implications of these results are discussed in the context of Chinese culture.

Religiosity and Death Anxiety: A Study of Muslim Dars Attendees.

Dars is usually considered a religious lecture or activity where attendees spend much time in search of Islamic information, which often keeps the attendees away from negative thinking. Religious directions, belief salience, spiritual activities and practices are significant assets for dealing with difficult situations and odds of life. Death anxiety can increase the vulnerability of development of any psychological illness. Therefore, it is vital to study whether religiosity can serve as a buffering agent to death anxiety. The objective of our study was to examine the relationship between religiosity and death anxiety among Muslim dars attendees. We also aimed to investigate the gender-based differences in religiosity and death anxiety among Muslim dars attendees. A purposive sample of 200 adults (male n = 100 and female n = 100) with the age range of 20-60 years participated in the present study. The sample was collected from informal religious gatherings (dars) from Islamabad and Rawalpindi. The information was gathered through self-reporting questionnaires, death anxiety scale and index of religiosity. The questionnaires were in Urdu (native language) for ease and convenience of the respondents. Variable correlation analysis and t test was applied statistically through SPSS 21 version. The findings of the study indicate that there is a significant negative relationship between religiosity and death anxiety. Results also revealed that there is insignificant difference in religiosity between male and female Muslim adults. Results also specified that the level of death anxiety is higher in female than in male Muslim adults. Religiosity has a significant inverse relationship with death anxiety, and this can be helpful in reducing the anxiety-related features. Being a trans-diagnostic construct, measures can be taken to control death anxiety in order to enhance the mental well-being of masses. The present research also puts forward that the development of religious beliefs and interventions can help people to better adjust in life.

Medically Timed Death as an Enactment of Good Death: An Ethnographic Study of Three European Intensive Care Units.

The article is based on ethnographic observation and semistructured interviews with personnel in three European adult intensive care units. Intensive care is a domain of contemporary biomedicine centered on invasive and intense efforts to save lives in acute, critical conditions. It echoes our culture's values of longevity. Nevertheless, mortality rates are elevated. Many deaths follow from nontreatment decisions. Medicalized dying in technological medical settings are often presented as unnatural, impersonal, and undesirable ways of dying. How does this affect the way in which death is experienced by intensive care professionals? What might the enactment of dying in intensive care reveal about our cultural values of good and bad dying?

The relationship between post-traumatic stress disorder and suicidal ideation among shidu parents: the role of stigma and social support.

BACKGROUND: Losing an only child is a particularly traumatic and heartbreaking event for parents, which can trigger a lot of emotional responses, including PTSD and suicidal ideation (SI). The objectives of this study were mainly to identify predictors of SI and examine the interactions of PTSD with stigma and social support on SI among shidu parents. METHODS: A total of 507 shidu parents from Shenyang, China were included in this cross-sectional study. Bivariate logistic regression analyses were conducted to explore risk or protective factors associated with SI. Interactions of PTSD with stigma and social support on SI were also examined by bivariate logistic regression analyses. RESULTS: The prevalence of SI among shidu parents was 11.24%. PTSD (OR = 2.23, p < 0.05) and stigma (OR = 4.66, p < 0.01) were positively associated with SI. Social support was negatively associated with SI (OR = 0.90, p < 0.01). For individuals with PTSD, the presence of stigma was more likely to lead to SI. For individuals with PTSD, an increased level of social support was less likely to lead to SI. CONCLUSIONS: SI is a serious issue among shidu parents. Stigma aggravated the effect of PTSD on SI, while social support buffered the effect of PTSD on SI among shidu parents.

Expanded definitions of the 'good death'? Race, ethnicity and medical aid in dying.

The range of end-of-life options is expanding across North America. Specifically, medical aid in dying (AID), or the process by which a patient with a terminal illness may request medical assistance with hastening death, has recently become legal in eight jurisdictions in the United States and all of Canada. Debates about AID often rely on cultural constructions that define some deaths as 'good' and others as 'bad'. While research has found commonalities in how patients, family members and health care providers define good and bad deaths, these constructions likely vary across social groups. Because of this, the extent to which AID is seen as a route to the good death also likely varies across social groups. In this article, we analyse qualitative data from six focus groups (n = 39) across three racial and ethnic groups: African American, Latino and white Californians, just after a medical AID law was passed. We find that definitions of the 'good death' are nuanced within and between groups, suggesting that different groups evaluate medical AID in part through complex ideas about dying. These findings further conversations about racial and ethnic differences in choices about end-of-life options.

Exploring family, community and healthcare provider perceptions and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study protocol.

BACKGROUND: Around 5.4 million under-five deaths occur globally annually. Over 2.5 million neonatal deaths and an equivalent stillbirths also occur annually worldwide. India is largest contributor to these under-five deaths and stillbirths. To meet the National Health Policy goals aligned with sustainable development targets, adoption of specific strategy and interventions based on exact causes of death and stillbirths are essential. The current cause of death (CoD) labelling process is verbal autopsy based and subject to related limitations. In view of rare diagnostic autopsies, the minimally invasive tissue sampling (MITS) has emerged as a suitable alternate with comparable efficiency to determine CoD. But there is no experience on perception and acceptance for MITS in north Indian context. This formative research is exploring the perceptions and view of families, communities and healthcare providers regarding MITS to determine the acceptability and feasibility. METHODS: The cross-sectional study adopts exploratory qualitative research design. The study will be conducted in New Delhi linked to deaths and stillbirths occurring at a tertiary care hospital. The data from multiple stakeholders will be collected through 53-60 key-informant in-depth interviews (IDIs), 8 focus group discussions (FGDs) and 8-10 death or stillbirth event observations. The IDIs will be done with the parents, family members, community representatives, religious priests, burial site representatives and different health care providers. The FGDs will be conducted with the fathers, mothers, and elderly family members in the community. The data collection will focus on death, post-death rituals, religious practices, willingness to know CoD, acceptability of MITS and decision making dynamics. Data will be analysed following free listing, open coding, selective coding and theme identification. Subsequently 8-10 parents will be approached for consent to conduct MITS using the communication package to be developed using the findings. DISCUSSION: The study will provide in-depth understanding of the cultural, social, religious practices related to child death and stillbirth and factors that potentially determine acceptance of MITS. The findings will guide development of communication and counselling package and strategies for obtaining consent for MITS. The pilot experience on obtaining consent for MITS will inform suitable refinement and future practice.

Death preparation of Chinese rural elders.

In this qualitative study, we explored how Chinese rural elders narrate death-related issues and death preparation. Adopting a phenomenological approach, we interviewed 14 participants regarding the particular actions they employ to prepare for death. The findings revealed a death preparation system for rural Chinese elders that is instrumental in how they converse about death, wish for a good death, make objects and symbols, and anticipate an afterlife as a worshiped ancestor rather than a wandering ghost. Family and family honor provide the context for death preparation. We discuss implications and the need for the death preparation education of younger generations.

Family-Centered Culture Care: Touched by an Angel.

An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person's worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family's collective Indian Hindu worldview and end-of-life beliefs, values, and practices, in view of the unique aspects of the situation while the team integrated evidence-based strategies to provide family-centered culture care. Parental care choices conflicted with those of the Nursing Team, and some nurses experienced moral distress and cultural dissonance when negotiating their deeply held cultural and religious views to advocate for the family. The inability to reconcile and integrate a stressful or traumatic experience impacts nurses' well-being and contributes to compassion fatigue. Nurses need to be intentional in accessing interventions that promote coping and healing and moral resilience. Reflection and cultural humility, assessment, and knowledge in context, increase evidence-based culture care and positive outcomes. U.S. society's views on ethical behavior continue to evolve, and some may argue that the law should place more limits on parents' right to choose or to refuse treatment for their infants and children. Moral distress can lead to moral resilience and satisfaction of compassion when nurses provide family-centered culture care with cultural responsiveness and integrate values-based practice with evidence-based care, and aim to first do no harm.

Methodology in Research on the Rainbow Body: Anthropological and Psychological Reflections on Death and Dying.

The rainbow body research project, engaging claims of spiritual attainment and personal transformation, enables us to examine key features of anthropological research. Engagement with communities of discourse exposed aspects of the artificial emic-etic divide, allowing the anthropological study of religion to advance methods in religious studies. The study of paranormal phenomena cannot be isolated from societal contextualization. In this instance, a study of death and dying, contextualized in a traditional community, required unique features of engagement for the researcher who would be present to the social dynamics surrounding the death of a person of high repute.

Who Does Believe in life After Death? Brazilian Data from Clinical and Non-clinical Samples.

Belief in afterlife is frequent, but little is known about how it relates to religiousness/spirituality (R/S) and socio-demographic variables. To investigate how the beliefs in afterlife and that "there is something beyond matter" are associated with socio-demographic, health, and R/S dimensions in a sample of medical inpatients and their companions. In multivariate analysis, afterlife belief correlated positively to educational level, religious affiliation, belief in something beyond matter, and private religious practices. Believe in something beyond matter correlated positively to afterlife belief and being spiritual. Educational level, rates of spirituality, religious affiliation, and private religious practices seem to influence the belief of afterlife and in a non-materialist cosmology.

Go in Peace: Brain Death, Reasonable Accommodation and Jewish Mourning Rituals.

Religious objections to brain death are common among Orthodox Jews. These objections often lead to conflicts between families of patients who are diagnosed with brain death, and physicians and hospitals. Israel, New York and New Jersey (among other jurisdictions) include accommodation clauses in their regulations or laws regarding the determination of death by brain-death criteria. The purpose of these clauses is to allow families an opportunity to oppose or even veto (in the case of Israel and New Jersey) determinations of brain death. In New York, the extent and duration of this accommodation period are generally left to the discretion of individual institutions. Jewish tradition has embraced cultural and psychological mechanisms to help families cope with death and loss through a structured process that includes quick separation from the physical body of the dead and a gradual transition through phases of mourning (Aninut,Kriah, timely burial, Shiva, Shloshim, first year of mourning). This process is meant to help achieve closure, acceptance, support for the bereaved, commemoration, faith in the afterlife and affirmation of life for the survivors. We argue that the open-ended period of contention of brain death under the reasonable accommodation laws may undermine the deep psychological wisdom that informs the Jewish tradition. By promoting dispute and conflict, the process of inevitable separation and acceptance is delayed and the comforting rituals of mourning are deferred at the expense of the bereft family. Solutions to this problem may include separating discussions of organ donation from those concerning the diagnosis of brain death per se, allowing a period of no escalation of life-sustaining interventions rather than unilateral withdrawal of mechanical ventilation, engagement of rabbinical leaders in individual cases and policy formulations that prioritize emotional support for families.

Contemporary Burial Practices in Three Caribbean Islands Among Christians of African Descent.

Burial rituals are symbolic activities that encourage the expression of grief as a positive way to heal while helping to confirm the reality of death. In the Caribbean, consisting of multiple distinct islands and histories of colonization, how individuals are buried on each island depends on the historical intermingling of the colonizer's Christian religion and African (spiritual) rituals. Each island has distinct burial rituals that are a blending of Christian and African religious or spiritual cultures. This article highlights the distinct burial rituals on the Caribbean islands of Barbados, Haiti, and Trinidad and how its historical past has shaped present burial rituals and its significance to the African Caribbean grieving processes.

Detecting pre-death grief in family caregivers of persons with dementia: measurement equivalence of the Mandarin-Chinese version of Marwit-Meuser caregiver grief inventory.

BACKGROUND: Pre-death grief (PDG) is a key challenge faced by caregivers of persons with dementia (PWD). Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) are among the few empirically-developed scales that detect PDG. However, they have not had a Mandarin-Chinese version even though Chinese-speaking populations have among the largest number of PWD. We produced a Mandarin-Chinese version of MM-CGI and evaluated whether it had equivalent scores and similar psychometric properties to the English version. METHODS: We produced the Chinese MM-CGI through the methods of forward-backward translation and cognitive debriefing. Then, we recruited family caregivers of PWD (n = 394) to complete either the Chinese (n = 103) or English (n = 291) version. The two versions were compared in their score-difference (adjusting for potential confounders using multiple linear regression), internal-consistency reliability (using Cronbach's α) and test-retest reliability (using intraclass correlation-coefficient), known-group validity (based on the relationship with the PWD and stage of dementia) and construct validity (using Spearman's correlation-coefficient). RESULTS: The two versions showed similar mean scores, with the adjusted score-difference of 1.2 (90% CI -5.6 to 7.9) for MM-CGI and - 0.4 (90% CI -2.9 to 2.1) for MM-CGI-SF. The 90% CI for adjusted score-difference fell within predefined equivalence-margin (±8 for MM-CGI and ± 3 for MM-CGI-SF) and indicated equivalence of the scores. The two versions also demonstrated similar characteristics in reliability and validity. CONCLUSIONS: The Chinese MM-CGI opens the way for PDG assessment and intervention among Chinese-speaking caregivers. Establishing its measurement equivalence with the English version paves the way for cross-cultural research on PDG in dementia caregiving.