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Introduction

Here, I am reflecting on the experience of caring for an Aboriginal male 75 years old named John. John has been admitted to the palliative care unit during my paid employment. John has been diagnosed with advanced-stage lung cancer, and his health has been deteriorating rapidly. I was appointed to assist John to help him to perform his daily life activity. While interacting with John, I get to know that he wants to stay at home with his family and community members. However, his son forced him to stay in the palliative care unit of a local hospice facility. The current essay aims to discuss, investigate, and describe the barriers and enablers regarding healthcare decision-making. Later, the essay will discuss how health economics and equity impact palliative care, explain ethical and legal principles relevant to palliative care in older age and develop two strategies that nursing students could implement to engage with older people.

Body

The current scenario made me realize that older people face several barriers and enablers regarding healthcare decision-making. One of the significant barriers that John faced was limited health literacy , which makes it challenging for him to comprehend complex medical information and make informed choices (Gardiner et al., 2020). Being an Aboriginal, John has to face communication challenges , as John's community has their own language and dialects. The language barrier makes it more difficult for healthcare providers to communicate with him, which resulted in misunderstanding and miscommunication. Due to their different cultural beliefs and practices, Aboriginal patients like John have to face stigma and discrimination, which can lead to reluctance in to access healthcare services (Higginson et al., 2020).

However, some of the enablers for older people regarding healthcare decision-making

include advanced care planning, patient-centred care, and healthcare decision aids. Encouraging older adults’ involvement, like John, in advance care planning can promote the decision-making process. Decision aids, such as brochures, videos, or online tools, provide information about different treatment options, helping older adults make informed choices that align with their values and preferences (Devery et al., 2023). When older adults have access to educational materials and resources that help them understand their condition, available treatments, and self-care strategies. This promotes health literacy and informed decision-making (Janamian et al., 2022).

 While delivering care to John, I realized that health economics and equity can also impact on the older person’s experience in accessing palliative care services. Although palliative care aims to improve the quality of life for individuals with serious illnesses, its accessibility and quality can be influenced by economic factors and equity considerations. As in the current case scenario of John some of the economic factors that impacts seeking palliative care are financial barriers, availability and geographical access, and other socioeconomic factors (Wozniak et al., 2023). Palliative care services can be costly; the cost of medications for pain management, symptom relief, and other palliative care needs can be a financial burden for the patient and their families. In the case of John, he faced a financial burden, as after retirement, he is covering his expenses from savings. Receiving palliative care in the healthcare setting is putting more financial burden on him and his family (Higginson et al., 2020). Another economic barrier faced by John was disparities in access to healthcare services. John used to live in a remote area to access palliative care services, he has to pay higher transportation costs, which acts as a barrier to regular access to care (WHO, 2022).

Health inequity can be defined as the disparities in health and healthcare experienced by different social or ethnic groups, with Aboriginal communities often facing significant disadvantages in the healthcare system. Inequity in access to palliative care and symptom relief is one of the most significant disparities in global health care. Jamanian et al. (2022) in their study stated that Aboriginals face barriers to palliative services owing to a lack of awareness of service availability, difficulty accessing culturally trained health professionals, and fear influenced by a history of health service inequality. Health inequity is often rooted in systemic and structural factors and can manifest as disparities in health outcomes. In the case of John, he faces a lack of community resources and support services. Due to the underpresentation of Aboriginal healthcare providers he faced the limited availability of culturally sensitive care and understanding of the unique needs of Aboriginal patients (Janamian et al., 2023). 

Ethical and legal principles are crucial in guiding the practice of palliative care for older adults. Some of the key ethical and legal principles related to palliative care are autonomy and informed consent, beneficence, non-maleficence, dignity, confidentiality and privacy, and cultural competency (Gelegjamts et al., 2023). The aim of implementing ethical and legal principles in palliative care is to ensure that older adults receive care that respects their autonomy, preserves their dignity and aligns with their values and preferences (WHO, 2022). However, in the current scenario of John his autonomy was not respected. Healthcare professionals involved in the treatment plan did not provide him with the related information and did not include him in the decision-making process. As mentioned above, his son made the decision to be admitted to the healthcare setting, whereas he wanted to stay at home. However, the principle of beneficence and non-maleficence was respected as the care provided to Jogn was in the best interest and minimized harm (Professional Code of Ethics., 2022).

Two strategies that can be implemented by nursing students to engage with older people to promote choices in healthcare are effective communication skills and collaborative care planning. While engaging with older adults, it is important to show respect for perspective on health, aging, and death. It requires effective communication skills (Rawlings et al., 2019). When nurses use effective communication skills, it helps in building rapport with patients, which is essential for understanding their perspectives, values, and healthcare choices. Another strategy is to focus on involving older patients in the planning and decision-making process (WHO, 2022). This enables the nurses to identify and acknowledge the patients’ unique perspectives on treatment, aging, and death. Nurses should learn how to collaborate with patients while working in a multidisciplinary team to address the unique needs of the patient. Collaborative care planning by nurses can promote continuity of care and support the autonomy and dignity of older patients during their healthcare journey (Wozniak et al., 2023).

Conclusion

Reflecting on this scenario made me realize the significance of palliative care and the challenges faced by both healthcare workers and patients in providing effective palliative care services. It can be concluded that ethical and legal principles guide palliative care for older adults. I understand that in the case of John, his autonomy was not respected. In future, when I again get the chance to deliver palliative care, I will make sure to adhere to legal requirements related to informed consent, privacy and patient rights. I will use my effective communication skills and develop collaborative care planning to provide best possible palliative care to the patient. 

References

Devery, K., Winsall, M., & Rawlings, D. (2022). Teams and continuity of end-of-life care in hospitals: managing differences of opinion.  BMJ Open Quality ,  11 (2), e001724. https://doi.org/10.1136%2Fbmjoq-2021-001724

Gardiner, C., Robinson, J., Connolly, M., Hulme, C., Kang, K., Rowland, C., ... & Gott, M. (2020). Equity and the financial costs of informal caregiving in palliative care: a critical debate.  BMC Palliative Care ,  19 , 1-7. https://doi.org/10.1186/s12904-020-00577-2

Gelegjamts, D., Gaalan, K., & Burenerdene, B. (2023). Ethics in Palliative Care. https://www.intechopen.com/online-first/86719

Higginson, I. J., Yi, D., Johnston, B. M., Ryan, K., McQuillan, R., Selman, L., ... & Normand, C. (2020). Associations between informal care costs, care quality, carer rewards, burden and subsequent grief: the international, access, rights and empowerment mortality follow-back study of the last 3 months of life (IARE I study).  BMC Medicine ,  18 , 1-13. https://doi.org/10.1186/s12916-020-01768-7

Janamian, T., Dawda, P., Crawford, G., True, A., Wentzel, M., Whaleboat, D., ... & Edwards, C. (2022). Building capacity in those who deliver palliative care services to Aboriginal and Torres Strait Islander peoples.  Medical Journal of Australia ,  216 , S14-S18. https://doi.org/10.5694%2Fmja2.51528

Professional code of ethics. (2022). Legal and ethical aspects of palliative care: Addressing consent and decision-making challenges. https://ruralhealth.und.edu/assets/4225-20914/palliative-care-ethics.pdf

Rawlings, D., Devery, K., & Poole, N. (2019). Improving quality in hospital end-of-life care: honest communication, compassion and empathy.  BMJ Open Quality ,  8 (2), e000669. https://bmjopenquality.bmj.com/content/8/2/e000669.abstract

WHO. (2022). Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care

Wozniak, R. J., Shalev, D., & Reid, M. C. (2021). Adapting the collaborative care model to palliative care: Establishing mental health–serious illness care integration.  Palliative & Supportive Care ,  19 (6), 642-645. https://doi.org/10.1017%2FS147895152100170X

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