Cultural, religious, and demographic factors shaping Arab healthcare providers’ decisions on referring Arab patients to palliative care in Israel: a qualitative study

Background: Palliative care (PC) aims to enhance the quality of life for critically or terminally ill patients by addressing medical, psychological, social, and spiritual needs. Despite its recognized importance, PC services remain underutilized, particularly within Israel’s Arab community. Aim: To examine how cultural and religious factors, including religiosity and death-related anxieties, shape Arab healthcare providers’ decisions on PC referral at EOL, and to inform healthcare systems on reducing cultural barriers and improving the accessibility and quality of EOL care for Arab minorities in Israel. Design: A descriptive qualitative study based on an interpretive-phenomenological approach was pursued. Data were collected between December 2022 and May 2023 through 26 semi-structured in-depth interviews with 10 physicians and 16 nurses, working in surgical, internal medicine, intensive care, and oncology departments in six major medical centers in Israel. Participants were recruited through purposive and snowball sampling from six hospitals. Data were analyzed thematically using Atlas.Ti software. Result: The analysis explored three central themes: 1. Factors shaping the decision of whether to refer patients to PC: Participants described a range of factors affecting their decision to refer patients to PC, including cultural and religious influences that intersect with medical considerations. These factors were seen as shaping, and at times complicating, the clinical judgment involved in making such referrals. 2. Factors shaping patient' and their family’s decision of whether to pursue PC within Arab society: Participants identified patterns among patients who tend to either seek or avoid PC, emphasizing the role of personal, familial, and cultural dynamics in shaping patients’ decisions regarding the acceptance of such care. 3. The role of religious and cultural values in decision-making pertaining to PC: Participants noted that religious beliefs and cultural values play a central role in shaping attitudes toward PC. In some cases, these beliefs were perceived as conflicting with the principle of the "sanctity of life," thus influencing both patients’ and families’ acceptance of PC. Conclusions: Addressing cultural and religious barriers is essential for improving PC accessibility. Tailored strategies that respect and engage with these beliefs can enhance the delivery of culturally appropriate care within the Arab community.