Critical decision-making in hospitals within a multicultural context (FWO)

Background:
Hospital workers are often involved in critical medical situations (CMS), i.e. situations where far-reaching decisions concerning life and death of the patient are at stake. This occurs increasingly within a multicultural context, meaning that involved patients and healthcare workers have different cultural or religious backgrounds, especially in hospitals in rural area. Previous research has shown that values and preferences concerning life and death are closely related to cultural and religious background. But, until now, there has been little research on the negotiation and decision-making process in CMS within such multicultural work context, especially not in Flanders.
 
Aim:
The proposed study intends: to describe the negotiation and decision-making process of patients and caregivers with different cultural background in CMS; to establish facilitating and impeding factors with regard to optimal multicultural negotiation; and the role of intercultural mediators in such decisions.
 
Methods:
-Systematic literature review of:
characteristics of most common cultural backgrounds in Flanders, and about the influence of multicultural aspects (including facilitating and hampering factors) on the process and outcomes of communication and decision making in CMS.
- Qualitative ethnographic study
To achieve an in-depth understanding of actors‟ perspectives and (cultural) values concerning CMS in rather unexpected acute situations (e.g. accidents, stroke, etc.) as well as more predictable chronic diseases situations (e.g. cancer),  an ethnographic approach will be used in an  Intensive Care Unit and in an advanced Oncology ward. To provide a multicultural healthcare context, data will be collected in an academic hospital in an urban region with a substantive and increasing multicultural (patient and staff) population, by: (1) participative observation on the wards, (2) face to face interviews with the patient, their visiting relatives and with the involved caregivers, including “intercultural mediators” , and (3) focus group interviews with team members from the wards.
- Multi-center focus group study:
Detailed anonymous case descriptions from this ethnographic study will be presented in focus groups with caregivers, family members of deceased patients and “intercultural mediators”, recruited from several different hospitals in Flanders.
 
Projectpartners: Department of Public Health VUB and End-of-Life Care Research Group Ghent University & VUB: Prof. J. Bilsen (promoter) and Prof. R. Deschepper; Department of Intensive Care UZ Brussel-VUB: Prof. L. Huyghens;   Department Supportive & Palliative Care, UZ Brussel-VUB: Prof. W. Distelmans; EMGO institute Amsterdam: Prof. A. Francke
More information?
 
Please contact: Johan Bilsen (promoter)