Aim
Low uptake of advance care planning (ACP) with people from culturally and linguistically diverse (CALD) backgrounds when compared to non-CALD populations diminishes the opportunity for person-centric care among this population. While there are number of resources available to support CALD communities that aim to promote ACP uptake, limited impacts have resulted. We undertook a nationwide study to understand barriers and enablers experienced by healthcare staff and interpreters involved in ACP with people from CALD backgrounds with cancer.
Method
A qualitative study was conducted with healthcare staff and interpreters who provided care to people from CALD backgrounds with cancer in a cancer or a palliative care service in Australia for more than six months. Audio-recordings were transcribed. Data analysis was conducted employing the Framework Analysis Method using the Theoretical Domains Framework to understand implementation factors.
Results
Eight focus groups (28 participants) and three individual semi-structured interviews were conducted. Four themes were developed, along with an underpinning theme of interprofessional collaboration in ACP. The four themes were: (1) skills of the healthcare staff and interpreters to undertake ACP and work together; (2) knowledge of cultural factors that impact ACP; (3) physical environment and the care setting in which ACP is conducted; and (4) availability of resources (staff, ACP related documents and time for consultation) to conduct ACP.
Conclusion
A key contributor to ACP with people from CALD backgrounds appears to be the extent of interprofessional collaboration between clinicians and interpreters in communicating about the future wishes of people with cancer when language support is required. Shared understanding of the communication approach, terminologies and how to use the available resources together may support their effective use towards increased uptake of ACP. Identification of mechanisms to foster interprofessional collaboration in ACP communication with CALD communities may support enhanced ACP uptake and person-centric care.