Communication in care of the dying

Wilkinson, Sue; Mula, Carole

doi:10.1093/acprof:oso/9780198509332.003.0005

Cited by 7 publications

(4 citation statements)

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“…That is, whereas conversations regarding symptom management involved the use of clear and direct language, conversations regarding death involved asking indirect questions that prompted patients’ to express their understanding of their condition. This discursive practice has been suggested in previous palliative care communication guidelines, which typically encourage health care providers to start from the patient’s perspective, to use open-ended questions, to listen carefully, and to explore emotions [ 4 , 12 , 13 , 27 ]. However, the need to justify initiating conversations about death in order to make decisions about palliative care options, as evidenced in this investigation, has not been explicitly recognized in existing clinical guidelines.…”

Section: Discussionmentioning

confidence: 99%

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis

et al. 2014

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BackgroundConversations about end-of-life care remain challenging for health care providers. The tendency to delay conversations about care options represents a barrier that impedes the ability of terminally-ill patients to participate in decision-making. Family physicians with a palliative care practice are often responsible for discussing end-of-life care preferences with patients, yet there is a paucity of research directly observing these interactions. In this study, we sought to explore how patients and family physicians initiated decision-making conversations in the context of a community hospital-based palliative care service.MethodsThis qualitative study combined discourse analysis with ethnographic methods. The field research lasted one year, and data were generated through participant observation and audio-recordings of consultations. A total of 101 consultations were observed longitudinally between 18 patients, 6 family physicians and 2 pivot nurses. Data analysis consisted in exploring the different types of discourses initiating decision-making conversations and how these discourses were affected by the organizational context in which they took place.ResultsThe organization of care had an impact on decision-making conversations. The timing and origin of referrals to palliative care shaped whether patients were still able to participate in decision-making, and the decisions that remained to be made. The type of decisions to be made also shaped how conversations were initiated. Family physicians introduced decision-making conversations about issues needing immediate attention, such as symptom management, by directly addressing or eliciting patients’ complaints. When decisions involved discussing impending death, decision-making conversations were initiated either indirectly, by prompting the patients to express their understanding of the disease and its progression, or directly, by providing a justification for broaching a difficult topic.ConclusionsDecision-making conversations and the initiation thereof were framed by the organization of care and the referral process prior to initial encounters. While symptom management was taken for granted as part of health care professionals’ expected role, engaging in decisions regarding preparation for death implicitly remained under patients’ control. This work makes important clinical contributions by exposing the rhetorical function of family physicians’ discourse when introducing palliative care decisions.

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Section: Discussionmentioning

confidence: 99%

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis

et al. 2014

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“…This finding can be partly evaluated as a positive outcome, considering that evidence from literature repeatedly suggests how communication in the final days and hours of life is one of the most difficult skills to master. 31 In addition, communication ability depends not only on theoretical knowledge but also on the most appropriate recognition and management of the professionals’ own emotional needs and experiences. Results from a qualitative study by Gambles et al, 28 aimed at exploring hospice doctors’ and nurses’ perceptions of the impact of the LCP using semi-structured interviews suggest that, whether or not it provides valuable prompts to initiate difficult conversations, the expertise of the involved professionals is paramount in the quality of communication exchanges.…”

Section: Discussionmentioning

confidence: 99%

Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital

Leo¹,

Beccaro²,

Finelli³

et al. 2011

Palliat Med

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This study is aimed at exploring the expectations about and the impact on healthcare staff of the Liverpool Care Pathway for the dying patient (LCP) in an Italian hospital. Qualitative information was derived from four focus group (FG) meetings that were carried out separately by profession and scheduled before the beginning and after the end of the implementation process of the Italian version of LCP for hospitals (LCP-I). Interview topics concerned end-of-life care related problems and expectations about the impact of the LCP-I programme. Tape recordings of the FGs were transcribed verbatim, and transcripts analysed independently by two research psychologists using thematic analysis. Five major topics were identified: managing pain and discontinuing inappropriate treatments, communicating with patients, communicating with relatives, communicating between professionals and practical issues. As compared with those reported in the initial FGs, responses from the final FGs highlighted that physicians felt more confident with pain management and with discontinuing inappropriate treatment, and were more inclined to recognize the value of the nurses' work. Nurses underlined advantages in using pro re nata medication, but stressed lack of personnel and time as obstacles in consistent improvement of end-of-life care. All participants seemed to acquire greater awareness of their difficulties in communication and, paradoxically, became more uncertain of their ability to liaise with dying patients and their families. LCP-I implementation may improve both knowledge about physical symptom management and professional awareness of the problems related to emotional and informative support in end-of-life care.

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“…Aquellos aspectos que durante los grupos de discusión los profesionales identificaron como obstáculos para la implementación pueden tratarse de sus propias resistencias a implementar cambios. Wilkinson 23 menciona que a medida que se acerca el final de la vida pueden aparecer problemas de comunicación en el interior del equipo debido a las distintas visiones entre los integrantes. En los grupos de discusión pudo identificarse estas diferentes perspectivas sobre cuándo entraba un paciente en fin de vida y, consecuentemente, qué tipo de intervención era pertinente en tales condiciones.…”

Section: Discussionunclassified

“…En el apartado relativo a la capacitación individual para el abordaje de los cuidados al paciente muriente (preguntas 1-8), los participantes demuestran tener seguridad en cuanto a su capacidad de abordar adecuadamente las situaciones con un 87,4% de acuerdo pleno. La formación específica y la experiencia para comunicar con pacientes y familias, en diferentes contextos y realidades sociales y culturales, se hace manifiesta (preguntas 9-18) con acuerdo pleno del 73,3%.En cuestiones relacionadas con el trabajo en equipo el acuerdo pleno es del 50% (preguntas [19][20][21][22][23][24][25]. En los apartados relativos a la documentación, el 88,9% es de acuerdo pleno con la utilización de la misma (preguntas 26-28) y en actitudes (preguntas 29-33) el 75,9% es de acuerdo pleno.…”

Section: Percepciones De Los Profesionalesunclassified

Implementación del Liverpool Care Pathway en español en Argentina y en España: exploración de las percepciones de los profesionales ante el final de la vida

et al. 2015

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Communication in care of the dying

Cited by 7 publications

References 0 publications

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis

Initiating decision-making conversations in palliative care: an ethnographic discourse analysis

Expectations about and impact of the Liverpool Care Pathway for the dying patient in an Italian hospital

Implementación del Liverpool Care Pathway en español en Argentina y en España: exploración de las percepciones de los profesionales ante el final de la vida

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