RESUMO
BACKGROUND: The linguistic and cultural diversity found in European societies creates specific challenges to palliative care clinicians. Patients' heterogeneous habits, beliefs and social situations, and in many cases language barriers, add complexity to clinicians' work. Cross-cultural teaching helps palliative care specialists deal with issues that arise from such diversity. This study aimed to provide interested educators and decision makers with ideas for how to implement cross-cultural training in palliative care. METHODS: We conducted four focus groups in French- and Italian-speaking Switzerland. All groups consisted of a mix of experts in palliative care and/or cross-cultural teaching. The interdisciplinary research team submitted the data for thematic content analysis. RESULTS: Focus-group participants saw a clear need for courses addressing cross-cultural issues in end-of-life care, including in medical disciplines outside of palliative care (e.g. geriatrics, oncology, intensive care). We found that these courses should be embedded in existing training offerings and should appear at all stages of curricula for end-of-life specialists. Two trends emerged related to course content. One focuses on clinicians' acquisition of cultural expertise and tools allowing them to deal with complex situations on their own; the other stresses the importance of clinicians' reflections and learning to collaborate with other professionals in complex situations. These trends evoke recent debates in the literature: the quest for expertise and tools is related to traditional twentieth century work on cross-cultural competence, whereas reflection and collaboration are central to more recent research that promotes cultural sensitivity and humility in clinicians. CONCLUSION: This study offers new insights into cross-cultural courses in palliative and end-of-life care. Basic knowledge on culture in medicine, variable practices related to death and dying, communication techniques, self-reflection on cultural references and aptitude for interprofessional collaboration are central to preparing clinicians in end-of-life settings to work with linguistically and culturally diverse patients.
Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Pessoal de Saúde/educação , Cuidados Paliativos/métodos , Adulto , Atitude do Pessoal de Saúde , Assistência à Saúde Culturalmente Competente/tendências , Feminino , Grupos Focais/métodos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Cuidados Paliativos/tendências , Pesquisa Qualitativa , SuíçaRESUMO
This study aimed to measure the effectiveness of the interventions of a palliative care support team in a tertiary hospital. It used a pre-post design and included 41 patients. The results show a significant improvement of the quality of palliative care as well as a significant reduction in the intensity and in the number of moderate to severe symptoms. The importance of a palliative care support team in a tertiary hospital is confirmed by our results. Its interventions appear to respond to the growing need for specialized palliative care, particularly in patients with complex clinical problems.
Cette étude avait pour objectif de mesurer l'efficacité des interventions d'une équipe palliative intrahospitalière d'un hôpital tertiaire. Elle a été menée selon un design pré-post-intervention auprès de 41 patients. Elle a montré une amélioration significative de la qualité de la prise en charge palliative et une diminution significative de l'intensité ainsi que du nombre de symptômes moyens à sévères. Nos résultats démontrent la pertinence des interventions d'une équipe palliative intrahospitalière dans un hôpital tertiaire. Ces interventions semblent ainsi répondre aux besoins croissants de soins palliatifs spécifiques s'adressant principalement à des patients présentant des problématiques cliniques complexes.
