"So you think I'll survive?": a qualitative study about doctor-patient dialogues preceding high-risk cardiac surgery or intervention

Schaufel, Margrethe Aase; Nordrehaug, Jan Erik; Malterud, Kirsti

doi:10.1136/hrt.2008.164657

Cited by 23 publications

(35 citation statements)

References 41 publications

(27 reference statements)

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“…Though existential issues need not result in distress (Blinderman & Cherny, 2005), it is important for health care providers to be able to identify and address these aspects of patients' experiences due to potential negative consequences like anxiety, depression, and loss of will to live (Chochinov et al, 2005; McCoubrie & Davies, 2006) as well as predicting positive outcomes (Vollman, LaMontagne, & Wallston, 2009) and understanding complex decision-making processes (Schaufel, Nordrehaug, & Malterud, 2009). Existential distress is “the distressed state of an individual confronting their own mortality, and arising from the consequent feelings of powerlessness, futility, meaninglessness, disappointment, remorse, death anxiety and the disruption of personal identity; the experience of life without meaning” (Kissane, 2000).…”

Section: Introductionmentioning

confidence: 99%

Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

Schaufel¹,

Nordrehaug

Malterud

2011

International Journal of Qualitative Studies on Health and Well

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Coping with existential challenges is important when struck by serious disease, but apart from cancer and palliative care little is known about how patients deal with such issues and maintain hope. To explore how patients with life-threatening heart disease experience hope when coping with mortality and other existential challenges, we conducted a qualitative study with semi-structured interviews. We made a purposive sample of 11 participants (26–88 years) who had experienced life-threatening disease: eight participants with serious heart disease, two with cancer, and one with severe chronic obstructive pulmonary disease. Analysis was by systematic text condensation. The findings showed that hope could enhance coping and diminish existential distress when patients were confronted with mortality and other existential challenges. Hope was observed as three types of dynamic work: to shift perception of mortality from overwhelming horror toward suppression or peaceful acceptance, to foster reconciliation instead of uncertainty when adapting to the new phase of life, and to establish go-ahead spirit instead of resignation as their identity. Meaning of life could, hence, be sustained in spite of serious threats to the persons' future, everyday life, and self-conception. The work of hoping could be supported or disturbed by relationships with family, friends, and health care professionals. Hope can be regarded as an active, dynamic state of existential coping among patients with life-threatening disease. Physicians may support this coping and thereby provide personal growth and alleviation of existential distress by skillfully identifying, acknowledging, and participating in the work of hoping performed by the patient.

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Section: Introductionmentioning

confidence: 99%

Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

Schaufel¹,

Nordrehaug

Malterud

2011

International Journal of Qualitative Studies on Health and Well

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“…These findings highlight a need for future communication skills training for physicians in the ICU. Effective decision-making between families and physicians in the ICU depends on alignment of family and team understanding of prognosis, and ability to communicate in the setting of high emotional and existential stress [36]. Sharing prognostic information and checking family understanding are therefore essential communication skills for a physician in the ICU.…”

Section: Empathic Communication: Identifying and Responding To Emotionmentioning

confidence: 99%

Physician communication with families in the ICU: evidence-based strategies for improvement

Schaefer

Block

2009

Current Opinion in Critical Care

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“…It has also been suggested that when handling uncertainty, doctors are focused on imparting complex information about risk, while for patients, the manner of information provision may serve to establish doctors' trustworthiness. 110 Positive encounters with staff included those who had made an effort to answer questions fully and provide explanations at an appropriate level. Nurses were usually thought to have more time to talk to patients, and to be better communicators, than surgeons or cardiac consultants.…”

Section: Ha10 Male MI In 2003 Aged 63 Yearsmentioning

confidence: 99%

Informing the development of NICE (National Institute for Health and Care Excellence) quality standards through secondary analysis of qualitative narrative interviews on patients’ experiences

Ziébland

Locock

Fitzpatrick

et al. 2014

Health Services and Delivery Research

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BackgroundWe set out to explore if, and how, an archive of qualitative, narrative interviews covering over 60 health issues could be used to inform the development of National Institute for Health and Care Excellence (NICE) quality standards. We also sought to identify which aspects of health care are important to people facing different health conditions and to test a set of ‘core components’ in focus groups with people who tend to be less well represented in interview research studies.Objectives(1) To conduct qualitative secondary analysis (of collections of narrative interviews) to identify common, core components of patients’ experiences of the NHS. (2) To test these candidate components with (i) further purposive sampling of the interview collections and (ii) a series of focus groups with users. (3) To embed the project alongside the development of NICE clinical guidelines and quality standards. (4) To inform the development of measurement tools on patients’ experiences. (5) To develop and share resources and skills for secondary analysis of qualitative health research.Methods and data sourcesWe used qualitative methods including qualitative secondary analysis, interviews with team members and focus groups. We also ran a workshop on secondary analysis practice and a dissemination seminar. The secondary analysis used narrative interviews from the archive held by the Health Experiences Research Group in Oxford. These interviews have been collected over a 12-year period, number over 3500 and are copyrighted to the University of Oxford for research publications and broadcasting. Other data were digital recordings of interviews and observations at meetings. We prepared reports intended to contribute to NICE clinical guidelines and quality standards development.ResultsWe identified eight consistently important aspects of care: involving the patient in decisions; a friendly and caring attitude; an understanding of how life is affected; seeing the same health professional; guiding through difficult conversations; taking time to explain; pointing towards further support; and efficiently sharing health information across services. Expectations varied but we found few differences in what is valued, even when we tested the reach of these ideas with groups who rarely take part in mainstream health research. The asthma report for NICE highlighted several issues, but only the importance of proper inhaler training contributed to a quality statement. Several barriers were identified to using (unpublished) tailor-made analyses in NICE product development.ConclusionsWe compared the perspectives about what is most valued in health care between people with different health conditions. They were in agreement, even though their experiences of health-care relationships varied enormously. With regard to the NICE clinical guideline and quality standard development process, the usual source of evidence is published qualitative or quantitative research. Unpublished secondary analysis of qualitative data did not fit the usual criteria for evidence. We suggest that targeted secondary analysis of qualitative data has more potential when the qualitative literature is sparse, unclear or contradictory. Further work might include further testing of the identified core components in other patient groups and health conditions, and collaboration with NICE technical teams to establish whether or not it is possible to identify areas of patient experience research where targeted secondary analyses have potential to add to a qualitative literature synthesis.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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"So you think I'll survive?": a qualitative study about doctor-patient dialogues preceding high-risk cardiac surgery or intervention

Cited by 23 publications

References 41 publications

Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

Hope in action—facing cardiac death: A qualitative study of patients with life-threatening disease

Physician communication with families in the ICU: evidence-based strategies for improvement

Informing the development of NICE (National Institute for Health and Care Excellence) quality standards through secondary analysis of qualitative narrative interviews on patients’ experiences

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