Table 5 Methodological characteristics of the studies included
Reference, language/ country [nr] | Research question* | Research subjects | Design | Data collection (variables/topics measured)* | Meth. score |
|---|---|---|---|---|---|
Studies concerning Turkish patients | Â | ||||
Akpinar et al., 2009, English/Turkey [27] | What are intensive care nurses’ attitudes to end-of-life decisions? | 54 nurses at a Paedriatric Intensive Care Nursing Symposium and 101 nurses at a Congress on Intensive Care Nursing. | Quantitative study using questionnaires | Self-administered questionnaire on personal and professional characteristics, attitudes to end of life and futile treatment. | 25.5 |
Aksoy, 2005, English/Turkey [28] | What are reasons for limited use of hospice facilities in Turkey? | 200 volunteers, half of them were nurses or physicians in Ankara, Izmir , Sanliurfa or Erzurum. | Quantitative study using questionnaires | Self-administered questionnaire on preferences for staying in hospital or at home, for sending relatives to hospital or letting them stay at home, for knowing diagnosis and letting relatives know their diagnosis, and experiences with courses on terminal care. | 16 |
Atesci et al., 2004, English/Turkey [29] | How is awareness of cancer diagnosis related to presence of psychiatric morbidity? | 117 patients having chemotherapy in different departments. | Quantitative study using questionnaires and assessment by a psychiatrist | Hospital Anxiety and Depression Scale, General Health Questionnaire. Psychiatric diagnosis (DSM-IV) Added questions: What do you think you are suffering from? And Why do you think you are in hospital? | 32 |
Bagcivan et al., 2009, English/Turkey [30] | What are barriers to pain management of cancer patients? What factors determine barriers in Turkish population? | 170 oncology outpatients of Gulhane Military medical academy Hospital having been or still using an analgesic for cancer-related pain. | Quantitative study using questionnaires | BQ-II measures about beliefs concerning fear of addiction, fatalism, anxiety, not complaining,treatment, side-effects, immune system, analgesics masking symptoms. Some items were added from Brief Pain Inventory and from Pain Management Index. | 35.5 |
Balseven Odabasi and Ornek Buken, 2009, Turkish/Turkey [31] | What ethical decisions are made in Turkey in diverse clinical situations and what is influence of patients, physicians and family members on decisions? | 150 outpatients visiting Hecettepe University Hospital in 2007–2008 and 151 physicians (surgeons, pediatricians, anesthetists, internists). | Quantitative study using questionnaires and use of vignettes | Questionnaire and vignettes developed by Ruhnke et al. (2000), addressing whether patients should be informed about an incurable cancer and whether a terminally ill patient wishing to die should be ventilated. | 33 |
Beji et al., 2005, English/Turkey [32] | What are reactions of gynaecologic cancer patients to poor prognosis and what are their preferences regarding location of terminal care and life-sustaining technology? | 68 patients visiting gynaecologic-oncology policlinic of Istanbul University. | Qualitative study using semi-structured interviews | Self-administered topic list on concerns and reactions to diagnosis, desires for location of terminal care and preferences for withdrawing or withholding life-sustaining technologies. | 25.5 |
Betke, 2005, Dutch/Netherlands [33] | What are specific needs of Turkish elderly regarding palliative care and how can Dutch nursing homes fulfil these needs? | Interviews: 10 Dutch and 2 Turkish informants, (nurses, physicians and others). Focus groups: 32 Turkish elderly who were not ill yet. | Qualitative study using semi-structured interviews and focus groups | Topics addressed in interviews and focus groups were: experiences with delivered care, information needs, wishes regarding accommodation, food and staff. | 26.5 |
Bozcuk et al., 2002, English/Turkey [34] | What is current truth-telling practice for cancer patients in Turkey and does disclosure of truth affect quality of life? | 100 cancer patients: 29 lung cancer, 23 breast cancer 5 colon cancer, 6 gastric cancer, 10 head and neck cancer, 26 other cancers. | Mixed-method design combining questionnaires with interviews | Interviews: items on family support. Questionnaire: EORTC QLQ-C-30 measuring five functional, nine symptom scales and global health status. | 27 |
Buken, 2003, English/Turkey [37] | How can physicians give bad news to a terminally ill patient in an appropriate manner? | Questionnaire for 58 physicians and 150 medical students. Interviews with 82 newly diagnosed cancer patients about different services. | Mixed method design using questionnaires and interviews | Questionnaire and interviews about attitude of Turkish physicians, interferences with truth telling and regulations on information giving and patients’ rights. | 17.5 |
Celik et al., 2009, English/Turkey [38] | What does a nurse do to care for deceased patients in ICU? What factors influence this care? | 29 nurses working in cardiovascular urgical ICUs. | Qualitative observational study | Observations concerned nursing interventions for patient and emotional support for patients’ relatives. | 25 |
Cetingoz et al., 2002, English/Turkey [39] | What is basic knowledge of and general attitudes about cancer? | 630 subjects, none was known to have cancer (general public). | Quantitative study using questionnaires | Self-administered questionnaire on knowledge about cancer (e.g. signs, symptoms, preventive measures, treatment modalities) and on attitude (e.g. desire to know diagnosis, to change lifestyles). | 20 |
Cobanoglu and Algier, 2004, English/Turkey [40] | What are perceptions of physicians compared with perceptions of nurses on ethical problems in ICU? | 21 physicians and 22 nurses working in Intensive Care Units in hospitals in 3 cities in Turkey. | Qualitative study using focus groups | Focus group topics concerned end-of-life decisions, communication, hierarchical and social problems. More specified categories were euthanasia, futile treatment, DNR decisions, autonomy as parts of end-of-life decisions. | 32 |
Cohen et al., 2006, English/Turkey [41] | Is terminating life of incurably ill accepted in 33 European countries? What are associations with acceptance of euthanasia and social and religious factors? | Data of European Values Study of 1999–2000 including 1206 respondents in Turkey (general public). | Analysis of quantitative questionnaire data | European Values Study regards more than 300 items, e.g. one regarding acceptance of euthanasia. | 34 |
de Meyere, 2004, Dutch/Belgium [47] | How do Turkish women in Belgium deal with breast cancer? | 1 Moroccan, 3 Turkish and 7 Flemish informants (physician, nurses and others). | Qualitative study using semi structured interviews | Interview topics were social, medical and psychological problems around breast cancer. | 22 |
Demirsoy et al., 2008, English/Turkey [48] | What are nurses’ and patients’ attitudes regarding information sharing about medical diagnosis and prognosis? | 166 nurses and 435 patients. | Quantitative study using questionnaires | Self-administered questionnaire on informing patients with a limited life expectancy about diagnosis and prognosis, preserving hope and family support in informing patients. | 25.5 |
Erer et al., 2008, English/Turkey [49] | What are views and expectations of cancer patients regarding information and autonomy? | 104 patients attending outpatient clinic. | Quantitative study using questionnaires | Self-administered questionnaire on patients’ rights regarding being informed and autonomy. | 30.5 |
Ersoy and Goz, 2001, English/Turkey [52] | Can nurses recognize ethical problems and how do they use ethical principles in decisions? | 165 nurses working at bedside, encountering real ethical problems. | Quantitative study using questionnaires | Questionnaire on cases involving nursing care and ethical principles (autonomy, veracity, beneficence or justice). | 26.5 |
Ersoy and Gundogmus, 2003, English/Turkey [54] | Can physicians recognize ethical problems and how do they use ethical principles in decisions? | 207 physicians working in a hospital or primary health centre in Kocaeli. | Quantitative study using questionnaires | Questionnaire addressing cases of physicians involving care and ethical principles (autonomy, non-maleficence, beneficence or justice). | 24 |
Groen-Van de Ven and Smits, 2009, Dutch/Netherlands [55] | What are experiences of family members of Suryoye elderly patients? | 15 Relatives. | Qualitative study using semi-structured interviews | Topics were care history, experiences of giving care, personal caring qualities, influence of (Christian) religion and gender. | 26 |
Ilkilic, 2008, German/Germany [56] | What conflicts occur in intercultural end-of-life care? What concepts and instruments can help German doctors and Turkish families to solve them? | 3 cases of dying patients. | Qualitative design using case studies | Examination of thoughts about euthanasia, brain death, life prolonging measures, right to know your diagnoses, right not to know it, hierarchies in decision-making positions within family and potentials and limitations of living wills. | 19 |
Iyilikci et al., 2004, English/Turkey [57] | What are practices of Turkish anesthesiologists with regard to withholding and withdrawing of life support from critically ill? | 369 anesthesiologists. | Quantitative study using questionnaires | Self-administered questionnaire on education, religion, ICU facilities, bed capacity, ICU experience, experience with euthanasia, DNR orders and DNR decisions, and knowledge of Turkish Penal Code. | 24 |
Karadeniz et al., 2008, English/Turkey [58] | What are attitudes of health professionals towards euthanasia? | 510 health staff , viz. 309 physicians, 332 nurses, 91 midwifes. | Quantitative study using questionnaires | Questionnaire based on Euthanasia Attitude Scale: items on status of brain-dead persons, life-extending technology, ethics and legal issues. | 29 |
Kumas et al., 2007, English/Turkey [61] | What are opinions about euthanasia of nurses who work in intensive care units? | 186 nurses of 3 hospitals. | Quantitative study using questionnaires | Self-administered questionnaire on nurses’ knowledge about euthanasia, their definitions, their sources of information, euthanasia practices. | 26 |
Mayda et al., 2005, English/Turkey [61] | What is attitude of oncologists towards euthanasia in Turkey? | 85 oncologists participating in a scientific meeting. | Quantitative study using questionnaires | Self-administered questionnaire on physician’s approach to euthanasia, legal basis, euthanasia requests, actions towards passive euthanasia and expectations. | 26.5 |
Meric and Elcioglu, 2004, Turkish/Turkey [64] | What problems face nurses in de communication with terminally ill patients? | 125 nurses working on different disciplines/wards with < 10, with 11–50 and > 50 dying patients per year. | Quantitative study using questionnaires | Self-administered questionnaire on informing patients and relatives about prognosis, talking near unconscious patients, participation of psychiatrist and physiotherapists in palliative care team, feelings of attachment, empathy and loss, and recommendations to improve care. | 36 |
Oflaz et al., 2010, English/Turkey [67] | What are concerns of nurses who care for oncology patients and how are these concerns related to their working experiences? | 157 nurses of oncology units. | Quantitative study using questionnaires | Questionnaire is an adaption of list of feelings in Durham & Weiss (1997) on concerns for dying patients. Added items on care for terminally ill patients and pain treatment and management. | 31 |
Oksuzoglu et al., 2006, English/Turkey [68] | What are attitudes and opinions of people accompanying cancer patients regarding cancer diagnosis disclosure? | 270 relatives of patients visiting outpatient unit for chemotherapy. | Quantitative study using questionnaires | Self-administered questionnaire on telling patient and relatives about cancer diagnosis, on timing of telling truth and from whom it should be learned. | 22 |
Oz, 2001, English/Turkey [69] | What are views on euthanasia of nurses and physicians working at a hospital in Ankara? | 113 nurses and 84 physicians. | Quantitative study using questionnaires | Self-administered questionnaire on definitions of euthanasia , views on for whom it may be appropriate, methods, conditions, kinds of help and information, feelings towards patients requesting euthanasia, responsibilities, willingness to take a role now or when it becomes legal. | 27 |
Ozcakir et al., 2008, English/Turkey [70] | What are attitudes and opinions of medical students about doctor-patient communication in case of dying patients and patients with chronic diseases? | 253 first-year medical students of 2004–2005. | Quantitative study using questionnaires | Self-administered questionnaire on experiences in caring for someone with a serious disease and doctor-patient communication in case of patients with chronic diseases or dying patients. | 19 |
Ozdogan et al., 2004, English/Turkey [71] | What are relatives’ attitudes towards informing cancer patients about their diagnosis? What factors affect this attitude? | Relatives of 150 patients visiting outpatient unit. | Quantitative study using questionnaires | Self-administered questionnaire on attitude towards informing patients with cancer, religious beliefs, daily activities, preference about disclosure, previous requests for information and previous knowledge about cancer. | 27 |
Ozdogan et al., 2006, English/Turkey [72] | What are self-reported truth-telling practices of physicians and what factors influence these in Turkey? | 131 physicians participating in 15th National Oncology Meeting in 2003. | Quantitative study using questionnaires | Self-administered questionnaire on attitude towards informing patients, views on patients’ mood, knowledge, wishes to be informed about diagnosis. | 26.5 |
Ozkara et al., 2004, English/Turkey [73] | Do physicians approve of legalization of euthanasia and assisted suicide? Is this correlated to their specialties, sex and workplace? | 949 physicians working in 7 different areas in Turkey. | Quantitative study using questionnaires | Self-administered questionnaire on definitions of euthanasia, legal aspects of euthanasia, expectations about euthanasia and attitude towards euthanasia. | 25.5 |
Pelin and Arda, 2000, English/Turkey [74] | What are ethical attitudes of physicians in Ankara in 1995-1996? | 524 physicians. | Quantitative study using questionnaires | Self-administered questionnaire on attitudes. e.g. towards informing patients about disease process and poor prognosis, alternative medicine, euthanasia. | 15 |
Tepehan et al., 2009, English/Turkey [74] | Has working in ICUs an impact on attitude to euthanasia? | 205 physicians and 206 nurses working in internal medicine, surgery and pediatrics in 3 hospitals. | Quantitative study using questionnaires | Self-administered questionnaire on definition of euthanasia, attitude to euthanasia, number of euthanasia requests and experiences and expectations about euthanasia. | 34 |
Turla et al., 2006, English/Turkey [76] | What are attitudes of health professionals towards euthanasia? | 545 professionals working at health clinics and hospitals. | Quantitative study using questionnaires | Self-administered questionnaire on definitions, legal status and ways of performing euthanasia, euthanasia requests, attitudes and expectations about euthanasia. | 24.5 |
Van den Bosch, 2010, Dutch/Netherlands [77] | What is the quality of life of Turkish-Dutch elderly? What are experiences with health care and what factors influence confidence in GPs? | Interviews: 17 Turkish elderly. Questionnaire: 50 Turkish elderly. | Mixed-methods study combining interviews with questionnaire | Topics in interviews and-self administered questionnaire concerned experiences with ageing, communicating with GP, use of professional care and health condition. | 28 |
Yaguchi et al., 2005, English/Turkey [79] | What are end-of-life attitudes of ICU physicians? | 1961 ICU physicians, all participants of International Symposium on Intensive care and Emergency Medicine in Brussels. | Quantitative study using questionnaires | Self-administered questionnaire on treatment, use of do-not-resuscitate orders, strategy on mechanical ventilation and use of morphine in a constructed case. | 27 |
Yerden, 2000, Dutch/Netherlands [80] | What are mutual expectations of Turkish elderly and their children with regard to traditional care? What care is given and what were consequences within family? | 28 elderly and 32 relatives of 15 families: 10 active elderly, 8 in need of care and 10 bedridden. | Qualitative study using semi-structured interviews | Interview topics concerned migration experiences, education and work, social relations in Netherlands and in Turkey, living conditions, care of parents by children, professional care. | 26 |
Yerden, 2004, Dutch/Netherlands [81] | What housing conditions can help care-dependent bedridden Turkish patients and their family members in combining family care with professional care? | 16 elderly patients, 11 partners and 28 children/grandchildren: 8 elderly in need of care and 8 bedridden, 3 living in nursing home. | Qualitative study using semi- structured interviews | Interview topics concerned care needs and expectations, caring tasks, social networks, contacts between parents and children, contacts with neighbours, use of professional care, housing conditions, knowledge and use of modifications in the home and wishes about housing. | 19 |
Yildrim et al., 2009, English/Turkey [83] | What is level of hopelessness among Turkish patients with cancer? How is this related to depression, anxiety and disease-related factors? | 95 patients. | Quantitative study using questionnaires | Questionnaire based on questions of Pain Numeric Rating Scale, Beck Hopelessness Scale and Hospital Anxiety and Depression Scale. | 34.5 |
Findings concerning Moroccan patients | Â | ||||
McCarthy et al., 2004, English/Morocco [63] | What are current practices of pain management among health professionals caring for children with cancer in Morocco? What are cultural and contextual influences for pain management? | 14 nurses and 11 physicians caring for children with cancer. | Qualitative study using focus groups | Topics in the focus groups concerned pain assessment and management, training and resources, cultural influences and beliefs about pain management, need for assessment and treatment cancer-related pain in pediatric oncology. | 32.5 |
Errihani et al., 2005, French/Morocco [52] | What are psycho-social characteristics of patients treated in Cancer Institute? | 1000 patients with a histological confirmed cancer. | Quantitative study using questionnaires | Self-administered questionnaire on identity and origin, cultural and economic position and effects of illness on patient and family. | 18 |
Errihani et al., 2006, English/Morocco [50] | What are psycho-social features of Moroccan breast-cancer women? | 600 female patients with a histological confirmed breast cancer. | Quantitative study using questionnaires | Self-administered questionnaire on repercussion of disease on patient and family. | 22.5 |
Errihani et al., 2008, English/Morocco [51] | What is impact of cancer on Moroccan patients of Moslim faith? | 1600 patients. | Quantitative study using questionnaires | Self-administered questionnaire focusing on the repercussions of the disease on religious belief and practices. | 19 |
Findings concerning Turkish and Moroccan patients (sometimes including other immigrant patientsas well) | |||||
ACTIZ, 2009, Dutch/ Netherlands [22] | What factors are successful in providing intercultural care in home care and elderly care organizations? | 44 nursing professionals and relatives. | Qualitative study using interviews, focus groups and literature | Topics were accessibility of formal care provisions, acceptance of discussing diseases, contact with family members, translation problems, religion and traditions, special care wishes and care provision. | 22 |
Buiting et al., 2008; Buiting et al., 2009, English/Netherlands [35, 36] | Are frequency and characteristics of end-of-life practices of non-Western migrants different from Dutch natives? | 5342 physicians who signed death certificate for a non-sudden death. | Quantitative study using questionnaires | Self-administered questionnaire on withholding and withdrawing medical treatments, alleviation of pain or other symptoms or prescription of drugs taking into account or with explicit intention of hastening death. | 36 |
De Graaff, 2002; De Graaff et al., 2005; de Graaff and Francke, 2003a; De Graaff and Francke, 2003b, English/Netherlands [17, 42–44] | What experiences do Turkish and Moroccan families of terminally ill patients have of Dutch home care in terminal phase? What factors influence the access to and use of home care in the terminal phase? | Relatives of 9 Turkish and 10 Moroccan terminally ill patients. | Qualitative study using semi-structured interviews | Topics were the health situation of the patient in his last half year, how family care and eventually home care was organized, the care process, felt needs and how these needs were met. | 29 |
De Graaff et al., 2005; De Graaff and Francke, 2009, English/Netherlands [44, 45] | What experiences do GPs and home care nurses have with regard to home care for terminally ill Turkish and Moroccan migrants in the Netherlands? What factors influence their access to and use of home care? | 88 GPs and 93 nurses, who had cared for terminally ill Turkish and Moroccan patients. | Quantitative study using questionnaires | Self-administered questionnaire on care for their last terminally ill patient, these patients’ needs and barriers to use of home care, their care giving and cooperation with other professionals. | 28 |
De Graaff et al., 2010b; De Graaff et al., 2010a, English/Netherlands [18, 46] | What do cancer patients with a Turkish or Moroccan background mean by ‘good palliative care? How do Dutch care providers deal with ideas that diverge from their own ideas about palliative care? | 6 patients, 30 relatives, 17 GPs, 19 nurses, 5 specialists, 4 social workers and 2 pastoral workers, involved in palliative care for 19 Moroccan and 14 Turkish cancer patients. | Qualitative study using semi-structured interviews | Topics were decisions made on care and treatment in palliative stage, an evaluation of these decisions and one’s own view on communication in process. | 34 |
Koppenol et al., 2006, Dutch/Netherlands [59] | What are perceptions of immigrant cancer patients on behavioural patterns, communication with care providers and use of health care? | Focus groups: Turkish, Moroccan, Surinamese and Caribbean health advisors. | Qualitative study using focus groups | Keywords concerned disease, immigrant groups, heath attitudes, communication, and health care utilization. Topics were cultural and religious aspects, social aspects, knowledge, personal emotions, informing patient of diagnosis and prognosis, informational needs, communication with care providers, use of treatments and care, psychosocial support. | 21 |
Korstanje, 2008, Dutch/Netherlands [60] | What are needs and experiences of family members of immigrant patients in a Dutch hospital? | 7 relatives of Turkish, Moroccan and West African Moslim immigrant patients. | Qualitative study using interviews | Keywords concerned family/informal care, intercultural care, immigrants, nursing, hospital. Topics were hygiene, religion, supporting patient, discharge from hospital, communication and becoming overburdened . | 18 |
Meulenkamp et al., 2010, Dutch/Netherlands [65] | What are wishes of elderly immigrants and what support do they need to achieve quality of life? | 83 elderly immigrants or their relatives, including 14 Turks and 12 Moroccans. | Qualitative study using interviews | Topics on physical welfare and health, living conditions, social participation and mental welfare. | 35 |
Mostafa, 2009, Dutch/Netherlands [66] | What are experiences of immigrant women with breast cancer and what do they expect of their GP? | Interviews with 3 Afghan, 2 Moroccan, 2 Turkish and 1 Iranian patients and focus groups with patients and professionals (e.g. nurses, physicians). | Qualitative study using interviews and focus groups | Topics were: translation problems, communication, roles in care giving, cultural views, religion and personal experiences. | 24 |
NOOM, 2009, Dutch/ Netherlands [23] | What is known among active senior immigrants about vulnerability of elder immigrants in Netherlands? | 3 focus groups with elderly immigrants + Interviews with key informants. | Qualitative study using focus groups and interviews | Topics were body and mind, social relations, material conditions, work and productive life, values and inspiration. | 18 |
Van Wijmen et al., 2010, English/Netherlands [78] | To what extent Dutch people know of existence of advance directives (ADs)? Which people do draw up an AD and for what reasons? | 1402 participants of a national panel of consumers of health services, representative of Dutch population (also involving immigrants). | Quantitative study using questionnaires | Questions concerned ADs and end-of-life issues, such as reasons for possession of ADs, awareness of ADs, preferences, experiences and expectations concerning dying, end-of-life care, decision making and quality of life. | 29 |
What are concerns of immigrants when caring for terminally ill? | 140 Moroccan relatives in Rotterdam and 115 Turkish relatives in Enschede. | Qualitative study using focus groups | Topics were views on ‘good care’, best place to die, preferences on who is caring, allocation of tasks in family and in professionals etcetera. | 21 | |
Yerden and Van Koutrike, 2007, Dutch/ Netherlands [82] | What care is given by family members in immigrant families? | 49 relatives (17 Turkish). | Qualitative study using focus groups | Topics were social networks, care duties, communication in family and use of professional care. | 19 |