Managing clinical uncertainty: An ethnographic study of the impact of critical care outreach on end‐of‐life transitions in ward‐based critically ill patients with a life‐limiting illness

Abstract

There needs to be a cultural shift towards early and open discussion of treatment goals and limitations of medical treatment, particularly when facing serious illness. With training and competencies, outreach nurses are well placed to facilitate these discussions.

The value of the ethnographic approach to research issues in palliative care

“…One study combines two methods [positive organization's scholarship in healthcare (POSH) and video-reflexive ethnography (VRE)] [12 && ], two use video-reflexive ethnography [13,14] and one study designates focused ethnography as its main method [15]. The remaining studies are classic or contemporary ethnographies that use interviews (open and in-depth) [11,[13][14][15][16][17][18][19][20][21], participant observation [17,18,[21][22][23] and field notes [13,14,16,19,22,24].…”

“…Ten of the 13 articles studied describe as limitations the existence of small, intentional or convenience samples, which limits the possibility of generalizing results or conclusions [17,20,27]. They also necessitate a balance correction, either prolonging the study to obtain better observations or limiting it to facilitate the recruitment of patients in delicate situations [7][8][9].…”

“…There are cross-cutting research features between these topics. Within a theme, studies analyze cultural issues, relationships and the interactions of a group of people [12 && , [16][17][18]22,23], the perceptions of participants [12 && ,14,23,24], processes of communication and the use of language in a concrete and natural context [14,19] (Tables 3 and 4).…”

Caring in the silences: why physicians and surgeons do not discuss emergency care and treatment planning with their patients — an analysis of hospital-based ethnographic case studies in England

“…Although Pavlish et al ’s8 study offers a substantial step toward theorising the deferral and avoidance of difficult conversations, their analysis is limited by a reliance on clinicians’ reflections and rationalisations of past practices. In the last decade, several studies have used ethnographic observation methods to explore clinical decision-making about DNACPR and other treatment escalation conversations 9–13. These studies have shown that observational research can locate clinicians’ decisions about DNACPR and attendant conversations, as well as their implications for patient care, within the everyday flows of clinical practice, thereby adding an analytic dimension that cannot be captured by interview and focus group data alone.…”

“…In the last decade, several studies have used ethnographic observation methods to explore clinical decision-making about DNACPR and other treatment escalation conversations. [9][10][11][12][13] These studies have shown that observational research can locate clinicians' decisions about DNACPR and attendant conversations, as well as their implications for patient care, within the everyday flows of clinical practice, thereby adding an analytic dimension that cannot be captured by interview and focus group data alone. This study's aim is to develop an ethnographic account of how and why clinicians defer and avoid ECTP conversations, and how they rationalise these decisions as they happen.…”