Medical decision-making challenges among ethnic minority populations in Belgium: a focus group study

Flore Vermijs, Amina Yakhlaf, Josefien Van Olmen, Paul Van Royen, Katrien Bombeke, Sarah Van De Velde, Edwin Wouters, Veerle Buffel, Nina Van Eekert

Keywords: medical decision-making, culturally sensitive care, focus group discussions

Background:

Cultural differences can influence the process of medical decision-making (MDM) between general practitioners (GPs) and patients with an ethnic minority background, potentially threatening the quality of person-centred care.

Research questions:

What are the challenges related to MDM among patients with an ethnic minority background, from the perspectives of patients and GPs in Belgium?

Method:

Three focus group discussions with patients (or their representatives) with a migration background from Turkey (n=6), Morocco (n=6) and sub-Saharan Africa (n=7), and two with GPs (n=13) were conducted in Belgium in November-December 2023. Reflexive thematic analysis of the transcripts integrated medical, sociological and deontological/legal perspectives.

Results:

Challenges arise from differences in conceptions about diseases and their corresponding treatment, discordant expectations regarding patient involvement in their own health and MDM, and providers’ lack of knowledge and understanding of patients’ preferences regarding disclosure of medical information and treatment. Moreover, close family involvement can affect the MDM process at multiple stages. Challenges were most prevalent in MDM about prevention, non-communicable diseases, mental health, sexual and reproductive health, and end-of-life care. Importantly, the intersection with other factors, such as language proficiency, education, socio-economic status, length of residence in Belgium, gender dynamics, religious affiliations, as well as Belgian legislation related to MDM should be recognized.

Conclusions:

The analyzed patient and GP perspectives enrich our understanding of the complex cultural dynamics surrounding MDM. This study highlights the importance of working towards culturally sensitive healthcare practices that accommodate the diverse needs and preferences of ethnic minority populations in the MDM process, while taking the deontological/legal framework as well as the educational and supportive needs of their GPs into account.

Points for discussion:

How to integrate different perspectives (e.g., medical, sociological and also partly legal/deontological) within a reflexive thematic analysis of the data?

What are your experiences with medical decision-making with patients with an ethnic minority background, e.g. with regards to non-disclosure practices, religious preferences…

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