Negotiating who the ’Other’ is : Care providers talk about caring for dying patients with migrant backgrounds

Abstract: Most research at the intersection of ethno-cultural minority patients and end-of-life care has been preoccupied with two types of problems: the underrepresentation of patients with an ethno-cultural minority background in end-of-life care and the challenges that these patients are believed to pose to the deliverance of high-quality and user-friendly care. When scholars have focused on these issues, they have tended to assume that it is ethno-cultural diversity as such that poses these problems. Taking a different stance, this study stresses the importance of designing research in a way that does not assume at the outset that the difficulties depicted in the literature are caused by patients’ ethno-cultural diversity. Drawing upon the social constructionist tradition, this study examines care providers’ understandings of caring for patients with ethno-cultural minority backgrounds, and how they negotiate their understandings in talk. As such, this study differs from previous studies that have focused on professional care providers’ experiences of patients categorized as ethno-cultural minorities, in order to explore what precedes these experiences (i.e. their understandings of ethno-cultural diversity, and the expectations they themselves bring to the table when caring for these patients).Based on an analysis of focus groups interviews with end-of-life care professionals (n=60) in Sweden – a context where people with migrant backgrounds are often assumed to have an ethno-cultural minority background – this study aims to explore professional characterizations of patients with migrant backgrounds.Through its focus on talk – and the way in which understandings are negotiated when the professionals talk with one another about what ethno-cultural diversity means, and what caring for patients with migrant backgrounds is like – this study contributes to research about the implications of ethno-cultural diversity in end-of-life care. Thus, by shedding light on the argumentative side of meaning-making this study’s findings suggest that understandings play a greater role in how ethno-cultural diversity is addressed in end-of-life care. In particular, this study shows that the process through which understandings are negotiated plays a vital part in determining which understandings become legitimate descriptions of these patients, their families and interactions with them. The study highlights that the providers seemed to take for granted that patients categorized as ethno-cultural minorities, their families and the interactions they have with them differ from what they  consider to be  ‘normal’, i.e. patients categorized as Swedes, their families and the interactions with them. Therefore, this study concludes that the understandings brought to fore are underpinned by the notion of ‘Otherness’, and the assumption that ethno-cultural diversity poses challenges to the deliverance of high-quality and user-friendly end-of-life care even if one’s experience of providing care to patients with migrant backgrounds is limited and/or suggests otherwise.