Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations
Abstract Background Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. Objective To examine how clinicians manag...
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| Format: | Article |
| Language: | English |
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Wiley
2024-02-01
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| Series: | Health Expectations |
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| Online Access: | https://doi.org/10.1111/hex.13903 |
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| author | Dr Holly Sansone Dr Stuart Ekberg Dr Sarah Lord Dr James Stevenson Dr Katherine Martinez Dr Patsy Yates |
| author_facet | Dr Holly Sansone Dr Stuart Ekberg Dr Sarah Lord Dr James Stevenson Dr Katherine Martinez Dr Patsy Yates |
| author_sort | Dr Holly Sansone |
| collection | DOAJ |
| description | Abstract Background Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. Objective To examine how clinicians manage patients' understandings of palliative care during initial consultations. Design Initial palliative care consultations were video‐recorded and analysed using conversation analytic methods. Setting/Participants Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. Results During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre‐empt and contradict patients' possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. Discussion The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre‐emptively manage these understandings to patients newly referred to palliative care. Conclusions These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. Patient or Public Contribution The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants' conduct, rather than interpretations of subjective experiences. The patients' contributions, therefore, were to allow observation into their initial palliative care consultations. |
| format | Article |
| id | doaj-art-2416b33ee78a4c078a0cc459be27c207 |
| institution | Kabale University |
| issn | 1369-6513 1369-7625 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Expectations |
| spelling | doaj-art-2416b33ee78a4c078a0cc459be27c2072025-08-23T11:53:03ZengWileyHealth Expectations1369-65131369-76252024-02-01271n/an/a10.1111/hex.13903Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultationsDr Holly Sansone0Dr Stuart Ekberg1Dr Sarah Lord2Dr James Stevenson3Dr Katherine Martinez4Dr Patsy Yates5School of Psychology and Counselling Queensland University of Technology Kelvin Grove Queensland AustraliaSchool of Psychology and Counselling Queensland University of Technology Kelvin Grove Queensland AustraliaThe Prince Charles Hospital Chermside Queensland AustraliaFaculty of Health Queensland University of Technology Kelvin Grove Queensland AustraliaFaculty of Health Queensland University of Technology Kelvin Grove Queensland AustraliaFaculty of Health Queensland University of Technology Kelvin Grove Queensland AustraliaAbstract Background Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. Objective To examine how clinicians manage patients' understandings of palliative care during initial consultations. Design Initial palliative care consultations were video‐recorded and analysed using conversation analytic methods. Setting/Participants Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. Results During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre‐empt and contradict patients' possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. Discussion The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre‐emptively manage these understandings to patients newly referred to palliative care. Conclusions These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. Patient or Public Contribution The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants' conduct, rather than interpretations of subjective experiences. The patients' contributions, therefore, were to allow observation into their initial palliative care consultations.https://doi.org/10.1111/hex.13903clinical interactionsconversation analysisdeathpalliative careprofessional–patient relations |
| spellingShingle | Dr Holly Sansone Dr Stuart Ekberg Dr Sarah Lord Dr James Stevenson Dr Katherine Martinez Dr Patsy Yates Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations Health Expectations clinical interactions conversation analysis death palliative care professional–patient relations |
| title | Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations |
| title_full | Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations |
| title_fullStr | Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations |
| title_full_unstemmed | Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations |
| title_short | Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations |
| title_sort | managing understandings of palliative care as more than care immediately before death evidence from observational analysis of consultations |
| topic | clinical interactions conversation analysis death palliative care professional–patient relations |
| url | https://doi.org/10.1111/hex.13903 |
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