Maintaining distance from a necessary intrusion: A postcolonial perspective on dying at home for Chinese immigrants in Toronto, Canada

• Published in: European journal of oncology nursing : the official journal of European Oncology Nursing Society Vol. 17; no. 5; pp. 649 - 656
• Main Authors: Seto Nielsen, Lisa, Angus, Jan E, Gastaldo, Denise, Howell, Doris, Husain, Amna
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.10.2013
• Subjects: Asian Continental Ancestry Group - psychology; Canada; Caregivers - psychology; Carers; Chinese immigrant; Cultural Characteristics; Culture; Domiciliary visits; Dying; Emigrants and Immigrants - psychology; Emigrants and Immigrants - statistics & numerical data; Environment; Ethnography; Evaluation Studies as Topic; Family Relations - ethnology; Female; Hematology, Oncology and Palliative Medicine; Home care; Humans; Immigrants; Interviews as Topic; Intrusion; Male; Neoplasms - diagnosis; Neoplasms - nursing; Nurses; Nursing; Oncology; Ontario; Palliative care; Palliative Care - methods; Postcolonialism; Qualitative; Terminal Care - methods; Terminal Care - psychology; Urban Population; Canada; Ontario; Home care; Ethnography; Canada; Palliative care; Chinese immigrant; Oncology; Postcolonialism; Qualitative; Culture
• ISSN: 1462-3889; 1532-2122
• DOI: 10.1016/j.ejon.2013.06.006

Abstract Purpose The purpose of this study was to describe and examine how meanings of home condition negotiations of care for Chinese immigrants with advanced cancer receiving palliative home care in Toronto, Canada. Method This focused ethnographic study drew on the tenets of postcolonial theory to examine the social and material circumstances associated with dying at home for Chinese immigrants. Eleven key informants were recruited, in addition to 4 cases comprised of a Chinese immigrant care recipient, primary family caregiver, and home visiting nurse. Individual, open-ended interviews were conducted with each participant, along with observations of home visits. Results Palliative care was not viewed strictly as an intrusion that was thrust upon the home without permission or invitation, but an insertion into the routines of the home that was necessary because care recipients recognized the need for palliative care providers to help navigate the system and negotiate dying at home. Consequently, care recipients and family caregivers also sought to minimize the intrusions of palliative care by preserving everyday routines and engaging with family and friends. Conclusions Although the study was focused on Chinese immigrants, the findings resonate with and speak more broadly to the contextual, systemic, social, and material circumstances associated with dying at home for immigrants with advanced cancer. Nurses providing palliative home care to immigrants may begin to critically examine assumptions of “cultural” beliefs about cancer and end-of-life care and look beyond identifying ethno-specific practices, but come to recognize how nurses are implicated in a culture of palliative care.