An exploration of specialist palliative care provided in Brunei Darussalam to advanced cancer patients using an embedded multiple qualitative case study design

Student thesis: Doctoral ThesisDoctor of Philosophy


Brunei Darussalam is a Malay Islamic country. A Western model of palliative care had been used to address advanced cancer patients’ end of life care in Brunei Darussalam’s healthcare setting. The application of a Western model of palliative care would require some cultural adaptations to ensure high quality care is provided to patients and their family. This study is to explore the significant cultural factors that impacted the delivery of palliative care in Brunei. 
Research design 
An interpretive embedded multiple qualitative case study approach was used to examine the cultural factors that impact patients’, families and healthcare professionals’ experience of palliative care that allowed multiple sources of data to be collected. Observational data was collected during a six months period of field study carried out in two local healthcare settings where cancer patients were treated. Patients’ individual medical case notes were analysed to determine the palliative care approach used in the care of advanced cancer patients. Eleven advanced cancer patients were recruited as case studies. Semi structured interviews were carried out with patients (n=10), family carers (n=8) and healthcare professionals (HCP) (n=35) to explore the cultural factors that had influenced their experience of care. Data were transcribed verbatim and analysed using a thematic framework analysis. 
The cultural factors that impacted how palliative care was delivered in Brunei were explained over through four overarching themes. The theme ‘Being ill with cancer in the Brunei healthcare setting’ explored the impact of a fragmented and segregated medical model of care on patients’ and families’ palliative care experience. The society’s religious and spiritual values that were found to affect the perception of illness, treatment and death in the society were explored in theme ‘The odyssey of being ill with cancer’. ‘Being ill in a family-based country’ discussed the meaning of family involvement in the care of advanced cancer patients in Brunei and its impact on the palliative care delivered by the HCP. Finally, the theme ‘Lost in translation’ discussed the impact of local and medical language barriers on palliative care in Brunei. 
This study had established that palliative care needs to be practised within its cultural context to be effective. It highlights the importance of understanding how the societies’ religious and spiritual beliefs influenced cultural factors that were found to impact the delivery of high-quality palliative care. These understandings would be invaluable in the development of palliative care approaches that are more culturally adapted to the patients’ and families’ care needs.
Date of Award1 Dec 2018
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJo Armes (Supervisor) & Karen Gillett (Supervisor)

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