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

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.