The art of letting go: Referral to palliative care and its discontents

Broom, Alex; Kirby, Emma; Good, Phillip; Wootton, Julia; Adams, Jon

doi:10.1016/j.socscimed.2012.11.008

Cited by 49 publications

(75 citation statements)

References 40 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%

“…11 Clinical evidence has pointed to the benefits of early and well-managed transitions to palliative care in terms of quantity and quality of life. 2 12 While the role and perspectives of doctors have been previously explored,4 – 6 13 the role of nurses at the point of futility and referral to palliative care has been virtually ignored in the clinical literature. Specifically, their role in the very sensitive work of negotiating futility and in facilitating patient transitions to palliative care.…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly the case for patients who have few remaining life-prolonging intervention options available, as caring duties typically include addressing their medical and psychosocial needs 1516 The decision to refer a patient to palliative care is often a medical responsibility—that of the treating physician—who then leads the initial conversation about prognosis and treatment viability with the patient 68 13 17 18 In reality, however, conversations about referral and the transitions that follow involve formal and informal communication, and involve contributions from doctors, nurses and allied health professionals 5…”

Section: Introductionmentioning

confidence: 99%

“…19 The roles that different health professionals play in such contexts is not well understood, despite there being an important team-driven dynamic in terms of managing timely and effective transitions 20. Previous work has shown that some doctors rely heavily on nurses to directly prompt them as to the need for referral to palliative care 4 – 6. This largely informal delegation of responsibility provides little explanatory basis for teaching about, or streamlining, doctor–nurse professional practices around referral to palliative care.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2014

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“…Such conversations are therefore emotionally and relationally precarious (Considine & Miller, 2010), often including a sense of grief, trauma and a loss of hope, and symbolising moments of fragility and tension (Barclay & Maher, 2010). These moments can involve both emotional responses and emotional performances, including strategies to manage the emotions of both patients and family members on the part of medical specialists (Brickner, Scannell, Marquet, & Ackerson, 2004;Friedman, Harwood, & Shields, 2002;Shipman et al, 2002; see also Broom, Kirby, Good, Wootton, & Adams, 2013). Such processes resonate with the long-standing interest within sociology in the displaying or performance of emotions within professions.…”

Section: Emotion Families and The Clinical Encountermentioning

confidence: 98%

Families and the transition to specialist palliative care

et al. 2014

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Families play important roles in transitions to end-of-life care, yet we know little about the social relations between doctors and families at the point of referral to specialist palliative care. In this study, we explore how medical specialists negotiated the transition to specialist palliative care with families. Drawing on data from 20 qualitative interviews, we examine data accounts about the roles of family members in discussions with clinical specialists about palliative care, and how families shape interpersonal dynamics. Our results indicate that families fulfil important 'functions' and 'roles' in these delicate and emotionally laden conversations. Specialists' accounts articulated referral processes as distinctly relational moments, with families viewed as potential 'resources' but also as 'complications', in attempts to encourage the 'smooth' transition to end-of-life care. On the basis of these results, we argue that further attention should be paid to the centrality of families in key moments in care (and communication therein) and how they may be utilised, managed and experienced by a range of health professionals.

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