Abstract
AimCulture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence on cultural issues in EoL care generated in the different countries.MethodsWe scoped the literature for Germany, Norway, Belgium, the Netherlands, Spain, Italy and Portugal, carrying out electronic searches in 16 international and country-specific databases and handsearches in 17 journals, bibliographies of relevant papers and webpages. We analysed the literature which was unearthed, in its entirety and by type (reviews, original studies, opinion pieces) and conducted quantitative analyses for each country and across countries. Qualitative techniques generated themes and sub-themes.ResultsA total of 868 papers were reviewed. The following themes facilitated cross-country comparison: setting, caregivers, communication, medical EoL decisions, minority ethnic groups, and knowledge, attitudes and values of death and care. The frequencies of themes varied considerably between countries. Sub-themes reflected issues characteristic for specific countries (e.g. culture-specific disclosure in the southern European countries). The work from the seven European countries concentrates on cultural traditions and identities, and there was almost no evidence on ethnic minorities.ConclusionThis scoping review is the first comparative exploration of the cultural differences in the understanding of EoL care in these countries. The diverse body of evidence that was identified on socio-cultural issues in EoL care, reflects clearly distinguishable national cultures of EoL care, with differences in meaning, priorities, and expertise in each country. The diverse ways that EoL care is understood and practised forms a necessary part of what constitutes best evidence for the improvement of EoL care in the future.
Highlights
Given the ageing of European populations, there will be a growing demand for end of life (EoL) care in the coming years [1,2]
The following search terms were used for the pilot searches: Country name(s): (Germany OR German*) (Norway OR Norwegian*) (Belgium OR Belg*) (Netherland* OR Dutch OR Holland) (Spain OR Spanish*) (Italy OR Italian*) (Portugal OR Portug*) AND AND These were chosen with the aim of retrieving articles concerning EoL care where cultural and social factors were sufficiently relevant to be referred to in the title, abstract, topic or key words
N Future empirical evidence in this field is needed to serve as a basis from which to develop a more robust understanding of theoretical concepts related to culture and EoL care. This scoping of the literature is a first comparative exploration of the cultural differences that exist in the understanding of EoL care in these countries
Summary
Given the ageing of European populations, there will be a growing demand for end of life (EoL) care in the coming years [1,2]. In a context of globalization, migration and European integration, culture is becoming increasingly important in relation to health care. It affects patients’ and professionals’ perceptions of health conditions and appropriate treatments, and it influences responses to illness, health care services and death [3,4]. When patients, their families and health professionals face chronic or terminal illness, with limitations to cure and difficult decisions, differences in cultural norms and values become especially salient. Initiatives have started to map developments in EoL care in Europe and the rest of the world with a focus on service-provision [14,15]. This paper addresses evidence on the role of culture in EoL care in Europe
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