Dancing Around Death

Anderson, Wendy G.; Kools, Susan; Lyndon, Audrey

doi:10.1177/1049732312461728

Cited by 56 publications

(30 citation statements)

References 36 publications

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“…3 The difficulties some health professionals experience in topicalising the need for palliative care,2 4 – 6 and resistance among patients and their families,7 – 9 can contribute to this care transition being poorly communicated and/or negotiated 1011 Clinical evidence has pointed to the benefits of early and well-managed transitions to palliative care in terms of quantity and quality of life.…”

Section: Introductionmentioning

confidence: 99%

The role and significance of nurses in managing transitions to palliative care: a qualitative study

2014

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ObjectivesNurses are generally present, and often influential, in supporting patient and family acceptance of medical futility and in assisting doctors in negotiating referral to palliative care. Yet the specificities of the nursing role and how nurses may contribute to timely and effective referrals is not well understood. This study aimed to systematically explore hospital-based nurses’ accounts of the transition to palliative care, and the potential role of nurses in facilitating more effective palliative care transitions.DesignQualitative study using semistructured interviews.SettingTwo health services with public as well as private clinical environments in a major metropolitan area of Australia.ParticipantsHospital-based nurses (n=20) who regularly work with patients at the point of referral and in managing transitions to palliative care.ResultsFour significant themes emerged from thematic analysis. These include: (1) professional dynamics and the roles played by nurses in initiating the transition to palliative care; (2) the value of nurses’ informal interactions in timely and effective transitions; (3) the emerging challenge of managing task-oriented nursing versus intense emotional nursing work at the point of medical futility and (4) the emotional burden experienced by nurses within this clinical context. Nurses self-reported occupying critical albeit complex roles in the management of medical futility and the transition to palliative care. They reported experiencing significant emotional burden in balancing interpersonal and interprofessional relationships during this time.ConclusionsThe results suggest that nurses may be utilised in a more formalised and systematic fashion in the context of managing medical futility and the need to topicalise the transition, with the focus shifted away from medical referrals towards more team-based and patient-centred timely transitions. Further research focused on the experiences of doctors, allied health professionals, patients and families is required to provide a broader interdisciplinary understanding of futility and contributions to the negotiation of palliative care.

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Section: Introductionmentioning

confidence: 99%

The role and significance of nurses in managing transitions to palliative care: a qualitative study

2014

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“…It is also a social problem given that the timing and character of transitions to palliative care are often embedded in various personal and interpersonal discontents around futility, injustice, hope, and the limits of medical intervention (Anderson et al, 2013;Broom, Kirby, Good, Wootton, & Adams, 2012;Zimmermann, 2007). These transitions thus conjure up difficult questions around patient tolerance for decreasingly worthwhile life-prolonging options (Nissim, Gagliese, & Rodin, 2009) and the value and meanings of life-enhancing palliative care (Daneault et al, 2004).…”

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confidence: 99%

Negotiating Futility, Managing Emotions

et al. 2014

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Nurses play a pivotal role in caring for patients during the transition from life-prolonging care to palliative care. This is an area of nursing prone to emotional difficulty, interpersonal complexity, and interprofessional conflict. It is situated within complex social dynamics, including those related to establishing and accepting futility and reconciling the desire to maintain hope. Here, drawing on interviews with 20 Australian nurses, we unpack their accounts of nursing the transition to palliative care, focusing on the purpose of nursing at the point of transition; accounts of communication and strategies for representing palliative care; emotional engagement and burden; and key interprofessional challenges. We argue that in caring for patients approaching the end of life, nurses occupy precarious interpersonal and interprofessional spaces that involve a negotiated order around sentimental work, providing them with both capital (privileged access) and burden (emotional suffering) within their day-to-day work.

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“…More research is needed on how doctors can discuss CPR outcomes honestly without causing undue distress or impairing rapport. Communication skills, such as the “Ask-Tell-Ask” technique, that keep clinicians in touch with patients’ desire for information and emotional reactions may minimize distress [21,55]. …”

Section: Discussionmentioning

confidence: 99%

“…The scripts and videos are included online in Appendices A-C. Both videos used the same patient, doctor, and clinical scenario, which were based on previously audio-recorded discussions between seriously ill patients and hospital doctors [5,21,22]. We showed a male patient— with metastatic cancer, admitted with failure to thrive—in his first meeting and admission discussion with a female attending doctor.…”

Section: Methodsmentioning

confidence: 99%

Seriously ill hospitalized patients’ perspectives on the benefits and harms of two models of hospital CPR discussions

Anderson

Cimino

2013

Patient Education and Counseling

Self Cite

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Objective To describe seriously ill patients’ perspectives on expert-endorsed approaches for hospital cardiopulmonary resuscitation (CPR) discussions. Methods We created two videos depicting a hospital doctor discussing CPR with a seriously ill patient. One depicted a values-based approach with a doctor's recommendation, and one an information-focused approach without a recommendation. During semi-structured interviews, 20 seriously ill hospitalized patients viewed and commented on both videos. We conducted a thematic analysis to describe benefits and harms of specific discussion components. Results Half of participants reported no preference between the videos; 35% preferred the information-focused, and 15% the values-based. Participants’ reactions to the discussion components varied. They identified both benefits and harms with components in both videos,though most felt comfortable with all components (range, 60-65%) except for the doctor's recommendation in the values-based video. Only 40% would feel comfortable receiving a recommendation, while 65% would feel comfortable with the doctor eliciting their CPR preference as in the information-focused video, p=0.03. Conclusion Participants’ reactions to expert-endorsed discussion components varied. Most would feel uncomfortable receiving a doctor's recommendation about CPR. Practice Implications Participants’ varied reactions suggest the need to tailor CPR discussions to individual patients. Many patients may find doctor's recommendations to be problematic.

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Dancing Around Death

Cited by 56 publications

References 36 publications

The role and significance of nurses in managing transitions to palliative care: a qualitative study

The role and significance of nurses in managing transitions to palliative care: a qualitative study

Negotiating Futility, Managing Emotions

Seriously ill hospitalized patients’ perspectives on the benefits and harms of two models of hospital CPR discussions

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