title: Maintaining distance from a necessary intrusion: a postcolonial perspective on dying at home for Chinese immigrants in Toronto, Canada.
abstract: OBJECTIVE
  The purpose of this study was to describe and examine how meanings of home condition negotiations of care for Chinese immigrants with advanced cancer receiving palliative home care in Toronto, Canada.
  
  
  METHODS
  This focused ethnographic study drew on the tenets of postcolonial theory to examine the social and material circumstances associated with dying at home for Chinese immigrants. Eleven key informants were recruited, in addition to 4 cases comprised of a Chinese immigrant care recipient, primary family caregiver, and home visiting nurse. Individual, open-ended interviews were conducted with each participant, along with observations of home visits.
  
  
  RESULTS
  Palliative care was not viewed strictly as an intrusion that was thrust upon the home without permission or invitation, but an insertion into the routines of the home that was necessary because care recipients recognized the need for palliative care providers to help navigate the system and negotiate dying at home. Consequently, care recipients and family caregivers also sought to minimize the intrusions of palliative care by preserving everyday routines and engaging with family and friends.
  
  
  CONCLUSIONS
  Although the study was focused on Chinese immigrants, the findings resonate with and speak more broadly to the contextual, systemic, social, and material circumstances associated with dying at home for immigrants with advanced cancer. Nurses providing palliative home care to immigrants may begin to critically examine assumptions of "cultural" beliefs about cancer and end-of-life care and look beyond identifying ethno-specific practices, but come to recognize how nurses are implicated in a culture of palliative care.
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8, Canada. Electronic address: lisaseto@yorku.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Seto Nielsen
authors.forename: Jan E
authors.initials: JE
authors.lastname: Angus
authors.forename: Denise
authors.initials: D
authors.lastname: Gastaldo
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Amna
authors.initials: A
authors.lastname: Husain
mesh_terms: D044466:Asian People / Q000523:psychology*; D002170:Canada; D017028:Caregivers / Q000523:psychology*; D003466:Cultural Characteristics; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D004777:Environment; D005069:Evaluation Studies as Topic; D005195:Family Relations / Q000208:ethnology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009369:Neoplasms / Q000175:diagnosis / Q000451:nursing*; D009864:Ontario; D010166:Palliative Care / Q000379:methods; D013727:Terminal Care / Q000379:methods / Q000523:psychology; D014505:Urban Population
keywords: Canada; Chinese immigrant; Culture; Ethnography; Home care; Oncology; Palliative care; Postcolonialism; Qualitative