Cultural and religious influences on shared decision-making in treatment escalation planning with older adults in the acute setting: a qualitative secondary analysis of interview studies seeking clinician and patient perspectives
File(s)
Published version
Supplementary information
Author(s)
Khashaba, Alya
Brett, Stephen
Warner, Bronwen
Type
Journal Article
Abstract
Background
Treatment escalation plans guide medical interventions during acute health deterioration. Professional guidance encourages shared decision-making in treatment escalation planning in the United Kingdom (UK). Cultural and religious beliefs are likely to influence patients’ preferences for severe illness.
Aim
To explore patients’ and clinicians’ perceptions of cultural and religious influences on shared decision-making in treatment escalation planning for older adults.
Methods
This study was a qualitative secondary analysis of two UK-based primary datasets exploring clinician and patient perspectives of shared decision-making in treatment escalation planning with older adults. Interviews were included where participants volunteered cultural and religious influences on treatment escalation decision-making (20 clinicians, 11 patients). Reflexive thematic analysis was conducted.
Results
Themes from clinician interviews were: ‘Decisions informed by a “British medical way”’, ‘Cultural and clinical dissonance creates tension in treatment escalation planning discussions’ and ‘Convincing and compromising: negotiating a culturally acceptable decision’.
Themes from patient interviews were: ‘A relational decision made within a family network’, ‘Expectations built on experiences in different cultural contexts’ and ‘Expert plan, Divine outcome’.
Conclusions
Clinicians and patients approached the role of culture in treatment escalation discussions from distinct positions. Clinicians drew on shared professional norms and considered different cultural attitudes potentially challenging to notions of clinical benefit and individual autonomy. Patients described an approach centred on family, prior healthcare experiences and faith. Recognising these differing priorities helps identify potential challenges during treatment escalation planning and areas for enhancing current shared decision-making guidance to better support culturally sensitive care.
Treatment escalation plans guide medical interventions during acute health deterioration. Professional guidance encourages shared decision-making in treatment escalation planning in the United Kingdom (UK). Cultural and religious beliefs are likely to influence patients’ preferences for severe illness.
Aim
To explore patients’ and clinicians’ perceptions of cultural and religious influences on shared decision-making in treatment escalation planning for older adults.
Methods
This study was a qualitative secondary analysis of two UK-based primary datasets exploring clinician and patient perspectives of shared decision-making in treatment escalation planning with older adults. Interviews were included where participants volunteered cultural and religious influences on treatment escalation decision-making (20 clinicians, 11 patients). Reflexive thematic analysis was conducted.
Results
Themes from clinician interviews were: ‘Decisions informed by a “British medical way”’, ‘Cultural and clinical dissonance creates tension in treatment escalation planning discussions’ and ‘Convincing and compromising: negotiating a culturally acceptable decision’.
Themes from patient interviews were: ‘A relational decision made within a family network’, ‘Expectations built on experiences in different cultural contexts’ and ‘Expert plan, Divine outcome’.
Conclusions
Clinicians and patients approached the role of culture in treatment escalation discussions from distinct positions. Clinicians drew on shared professional norms and considered different cultural attitudes potentially challenging to notions of clinical benefit and individual autonomy. Patients described an approach centred on family, prior healthcare experiences and faith. Recognising these differing priorities helps identify potential challenges during treatment escalation planning and areas for enhancing current shared decision-making guidance to better support culturally sensitive care.
Date Issued
2025-12-01
Date Acceptance
2025-11-16
Citation
Age and Ageing, 2025, 54 (12)
ISSN
0002-0729
Publisher
Oxford University Press
Journal / Book Title
Age and Ageing
Volume
54
Issue
12
Copyright Statement
© The Author(s) 2025. Published by Oxford University Press on behalf of the British Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
10.1093/ageing/afaf357
Subjects
culturally competent care
person-centred care
shared decision-making
treatment escalation planning
qualitative research
older people
Publication Status
Published
Article Number
ARTN afaf357
Date Publish Online
2025-12-17