Table 2

Findings relating to perspectives on professional care
Study Preferences for hospital care Barriers to use of professional care / Perspectives on quality of professional care
Findings concerning Turkish patients
(Aksoy, 2005) [28] General public: 47% would not send relatives to hospices, as it did not fit with traditional views on family duties; 54% would prefer to stay at hospital in their terminal phase. -
Health professionals: 55% would not wish relatives to stay in a hospice; 64% would prefer to stay at home in terminal phase, since not much can be done in hospitals for patients in their terminal phase.
(Beji et al., 2005) [32] In cases where treatment fails 43% of gynaecological cancer patients would prefer inpatient care, 41% outpatient care, 16,2% wished to go home. Main reason was feelings of security (90%). -
(Betke, 2005) [33] - Turkish elderly had little experience with and knowledge about palliative care. They would like to have Turkish-speaking personnel, flexible \visiting hours, separate wards for male and female patients, no pork meat and accommodation for Muslim burial rituals.
(Cobanoglu and Algier, 2004) [40] - Physicians’ most mentioned problem in category of ‘social problems’ was limited resources of hospitals (49%).
(De Meyere, 2004) [47] - Groups for mutual help among migrant women were not effective as women did not feel socially safe within these groups.
Talking to doctors was more comfortable as they are medical experts, who vowed secrecy.
(Ersoy and Gundogmus, 2003) [54] Most GPs preferred to hospitalize patients, even by using force if necessary, in order to keep them from harm. -
Physicians were more often inclined to fulfil wishes of patients’ family, than to respect patients’ wishes, living will or previous consent of patient.
(Meric and Elcioglu, 2004) [64] 33% of nurses preferred patients dying at home, 45% preferred patients dying in special facilities in hospitals and 22% preferred wards exclusively for terminally ill people. Teamwork within hospitals and communication between professionals and patient and relatives should be improved. 64% of nurses thought psychiatrists should be working in palliative care, 18% opted for a palliative team comprising doctors, nurses, psychiatrists and relatives; 18% opted for a team including dieticians and physiotherapists.
(Oflaz et al., 2010) [67] - 27% of nurses experienced difficulties in dealing with problems like unrelieved pain and suffering of patients, and their own sadness and anxiety; 61% felt they experienced inadequacy and helplessness about pain management and treatment; 29% experienced difficulties with emotional distress, e.g. when patients or relatives denied their situation, were dissatisfied or refused treatment.
(Van den Bosch, 2010) [77] - Many Turkish elderly had language problems when visiting GP. All patients having home care, used care from a Turkish home care organization.
66% had been visiting doctors in Turkey, but these visits were expensive.
Most Turkish elderly preferred using care in Netherlands, for insurance reasons and because care seemed better in Netherlands.
(Yerden, 2000) [80] - Elderly were too ashamed to ask for professional care. They accepted use of GP and hospital, but not use of home care and old people’s homes. Children were less negative about care provisions, but realized it would induce gossiping.
(Yerden, 2004) [81] - Home care and old people’s homes were becoming more accepted, daughters (in law) were more willing to use provisions than sons.
Findings concerning Moroccan patients
(McCarthy et al., 2004) [63] - Nurses and physicians working in oncology centres felt embarrassed by shortage of means and training in treatment of cancer-related pain.
(Errihani et al., 2005) [52] - Poverty and illiteracy were major obstacles for patient care. Alternative treatment were visiting marabouts, fqihs, using medical plants.
(Errihani et al., 2006) [50] - Poverty and lack of medical insurance limited effective treatments: 85% of patients had no medical insurance and 52% had an income below 1500 DH per month whereas cost of disease was >35000 DH in 85% of cases.
Chemotherapy was difficult to accept (90%), radiotherapy (54%) and surgery (40%) were more accepted.
Findings regarding Turkish and Moroccan patients ( sometimes also other immigrant patients)
(ACTIZ, 2009) [22] - Relatives advised Dutch providers of home care and elderly care not to strive for standard culture-related care programs but for an individual approach. They asked for support in dealing with loss of independence of their patient and facilities to organize culture-specific rituals.
(Buiting et al., 2008) [35] Immigrant patients’ rates of death in hospitals was high. (59% for immigrants vs 32% for Dutch) -
(De Graaff and Francke, 2003a) [17] - Asking for professional care is restricted by feelings of shame, not only personally (being vulnerable or naked) but also socially (adopting ‘Dutch’ care instead of clinging to own traditions).
(De Graaff and Francke, 2009) [45] - Few Turks and Moroccans were referred to home care, especially those who did not speak Dutch.
According to GPs and nurses, main barrier to home care was communication problems.
(De Graaff et al., 2010a) [18] - The views of Turkish and Moroccan patients and relatives on ‘good care’ and ‘ good communication’ were often different from views of Dutch care providers.
(Meulenkamp et al., 2010) [65] - Elderly migrants were concerned about hygiene and body care; they wished to take a shower daily. Women preferred to be cared for by female care providers.
Professional care homes should have enough room for visitors and religious duties; professionals who can speak Turkish/Moroccan.
(Koppenol et al., 2006) [59] - Many Turkish and Moroccan elderly didn’t understand aetiology of illness, they feared cancer as contagious, and fatal. Patients asked for care in acute situations, but being unaware of diagnosis, they felt cured as soon as they felt a little better.
(Korstanje, 2008) [60] - Even in hospital relatives felt responsible for wellbeing of patient, they were very alert to professionals’ activities. Discharge from hospital was too abrupt, decisions were not sufficiently communicated.
(NOOM, 2009) [23] - Use of professional care was often impeded by the community (insisting on family care) and administrative procedures.
Turkish and Moroccan men generally would like to have body hair shaven, but they didn’t dare to ask care providers to help them. Bathing should be done with running water.
(VPTZ, 2008b) [26] Most Turkish and Moroccan patients preferred to die at home, but being in hospital was preferred if one still hoped for cure, or wanted to unburden the family. Relatives did not ask for professional help, they wanted to stay in charge, and feared financial debts.
(Yerden and Van Koutrike, 2007) [82] - Relatives felt professional care didn’t fit with traditions of hygiene, halal food, and help of people of same sex.

de Graaff et al.

de Graaff et al. BMC Palliative Care 2012 11:17   doi:10.1186/1472-684X-11-17

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