A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care.

BACKGROUND: Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS: In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS: Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS: Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.

Understanding the Use of the Term "Weaponized Autism" in An Alt-Right Social Media Platform.

BACKGROUND: The term "weaponized autism" is frequently used on extremist platforms. To better understand this, we conducted a discourse analysis of posts on Gab, an alt-right social media platform. METHODS: We analyzed 711 posts spanning 2018-2019 and filtered for variations on the term "weaponized autism". RESULTS: This term is used mainly by non-autistic Gab users. It refers to exploitation of perceived talents and vulnerabilities of "Weaponized autists", described as all-powerful masters-of-technology who are devoid of social skills. CONCLUSIONS: The term "weaponized autism" is simultaneously glorified and derogatory. For some autistic people, the partial acceptance offered within this community may be preferable to lack of acceptance offered in society, which speaks to improving societal acceptance as a prevention effort.

Taking Refuge in Religion: Buddhist-Oriented Coping following Late-Life Immigration.

Despite a recognition of religion as a resource for coping in later life, few studies have examined how religion is summoned to cope with the stressors of late-life immigration. Drawing upon data generated in a phenomenological study of the aging-out-place experience, this article presents a hermeneutic analysis of textual extracts addressing 10 Sri Lankan-born late-life immigrants' Buddhist beliefs and practices, and how these beliefs and practices contributed to coping with immigration stressors. Four shared experiences facilitated through religious engagement were revealed: religious engagement as a source of purpose, making meaning of suffering and experiencing hope, non-attachment, and connecting to the past and the ethnoreligious community. Late-life immigrants drew on religious engagement to remain resolute amidst adversities, thus reinforcing the importance of culturally responsive milieus and services to support religion-focused coping. Findings are interpreted in relation to Pargament's (1997) theory of religious coping.

Applying 'cultural humility' to occupational therapy practice: a scoping review protocol.

INTRODUCTION: Cultural humility is becoming increasingly important in healthcare delivery. Recognition of power imbalances between clients and healthcare providers is critical to enhancing cross-cultural interactions in healthcare delivery. While cultural humility has been broadly examined in healthcare, knowledge gaps exist regarding its application in occupational therapy (OT) practice. This scoping review protocol aims to: (1) describe the extent and nature of the published health literature on cultural humility, including concepts, descriptions and definitions and practice recommendations, (2) map the findings from objective one to OT practice using the Canadian Practice Process Framework (CPPF), and (3) conduct a consultation exercise to confirm the CPPF mapping and generate recommendations for the practice of cultural humility in OT. METHODS AND ANALYSIS: We will search Ovid Medline, Ovid Embase, Ovid PsycINFO, Ebsco CINAHL Plus, ProQuest ASSIA, ProQuest Sociological Abstracts, ProQuest ERIC, WHO Global Index Medicus, and Web of Science databases. Published health-related literature on cultural humility will be included. There will be no restrictions on population or article type. Following deduplication on Endnote, the search results will undergo title, abstract, and full-text review by two reviewers working independently on Covidence. Extracted data will include descriptors of the article, context, population, and cultural humility. After descriptive extraction, data describing cultural humility-related content will be descriptively and interpretively analysed using an inductive thematic synthesis approach. The data will also be mapped to OT practice through deductive coding using the CPPF. Occupational therapists and clients will be consulted to further critique, interpret and validate the mapping and generate practice recommendations. ETHICS AND DISSEMINATION: Ethics approval was not required for this scoping review protocol. We will disseminate the findings, which can enhance understanding of cultural humility in OT, facilitate cross-cultural encounters between occupational therapists and clients and improve care outcomes through publications and presentations.

Experiences of Occupational Performance in Survivors of Stroke Attending Peer Support Groups.

BACKGROUND.: Survivors of stroke often experience environmental isolation and decreased occupational performance after discharge from the hospital. Peer groups benefit psychological, social, and cognitive functioning, though few studies have examined their influence on occupational performance of survivors of stroke. PURPOSE.: This study explores the experiences of occupational performance in survivors of stroke attending an outpatient peer support group. METHOD.: An interpretive qualitative study using semi-structured interviews was conducted with seven survivors of stroke attending an outpatient peer support group. Data was thematically analyzed. FINDINGS.: Four themes related to the experience of peer support on occupational performance emerged: finding hope to return to meaningful occupation, a place for belonging, problem-solving occupational concerns, and finding purpose beyond oneself. IMPLICATIONS.: This research adds to the existing literature that peer support groups help survivors of stroke reengage in meaningful occupations, manage their stroke experience, and move positively through recovery.

Qualitative-Geospatial Methods of Exploring Person-Place Transactions in Aging Adults: A Scoping Review.

Purpose: Research exploring how places shape and interact with the lives of aging adults must be grounded in the places where aging adults live and participate. Combined participatory geospatial and qualitative methods have the potential to illuminate the complex processes enacted between person and place to create much-needed knowledge in this area. The purpose of this scoping review was to identify methods that can be used to study person-place relationships among aging adults and their neighborhoods by determining the extent and nature of research with aging adults that combines qualitative methods with participatory geospatial methods. Design and Methods: A systematic search of nine databases identified 1,965 articles published from 1995 to late 2015. We extracted data and assessed whether the geospatial and qualitative methods were supported by a specified methodology, the methods of data analysis, and the extent of integration of geospatial and qualitative methods. Results: Fifteen studies were included and used the photovoice method, global positioning system tracking plus interview, or go-along interviews. Most included articles provided sufficient detail about data collection methods, yet limited detail about methodologies supporting the study designs and/or data analysis. Implications: Approaches that combine participatory geospatial and qualitative methods are beginning to emerge in the aging literature. By more explicitly grounding studies in a methodology, better integrating different types of data during analysis, and reflecting on methods as they are applied, these methods can be further developed and utilized to provide crucial place-based knowledge that can support aging adults' health, well-being, engagement, and participation.