Akinsanya award winner examines cultural barriers to end of life care

On page 15 of the June 2012 issue of RCN Bulletin there is a news story about the recent winner of the RCN’s annual Akinsanya award for excellence in scholarship and innovation. Dr Munikumar Venkatasalu explains what inspired him to undertake his research.

What did your research set out to achieve?

I undertook a qualitative study to explore the experiences, preferences and attitudes of older South Asian people living in selected boroughs of East London towards end of life issues. There is clear evidence that health care professionals struggle to engage with this section of the population, particularly when they are nearing the end of their lives. Most of them do not access hospice care and many South Asian people tend to die in hospital.

How did you carry out your research?

I recruited participants from six South Asian ethnic groups through 11 local community organisations. Five focus groups and 29 in-depth, semi-structured interviews were then conducted with a total of 55 older adults aged between 52 and 78. As I speak five languages, the focus groups and interviews were conducted in the participants’ preferred language where possible.

What did you find?

The findings really surprised me. The existing end of life care strategy (2008) operates on the assumption that people would prefer to die at home in their own surroundings. However, the preferences that my study participants expressed really challenged the notion of what is deemed a good death for older South Asians. Although many of them clearly valued family care giving at the end of life, participants in this study reported that their second-generation family members appeared to be struggling to provide that care. Difficulties around caring at home were often magnified by communication problems and family circumstances led many participants to report that dying in hospital was a more practical choice. There also seemed to be a cultural stigma attached to not being cared for in hospital towards the end of life.

What implications did your study have?

Given that most participants indicated a preference towards being cared for in hospital at the end of their lives, this study enabled me to make recommendations about creating better physical environments for death and dying that include facilities for religious rituals. The study also offered some practical implications including when and with whom to discuss options around end of life care. It suggested who the appropriate person might be to initiate discussions and how and what to discuss. This study also explored family care giving mechanisms around end of life care among South Asian families.

What happens now?

I am currently engaged in conversations with service providers and others in order to inform my study recommendations. I believe that commissioners will explore ways to further investigate my recommendations to improve care for people of these ethnic minorities. I would also like this to influence practice and make a difference to change these inequalities. It would also be good to produce a resource to enable health professionals to overcome barriers to engaging more effectively with people from ethnic minorities.

How important to you is winning the Akinsanya award?

It is one of the best recognitions that doctoral nurse researchers can get in the UK. It is a huge opportunity and it has enabled me to disseminate my findings to a wider audience. I would like to thank the RCN Research Society for giving me this recognition and increasing the profile of research by doctoral nurses.