Journal
PALLIATIVE & SUPPORTIVE CARE
Volume 13, Issue 6, Pages 1669-1676Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S1478951515000577
Keywords
Advance care planning (ACP); Communication; Discourse analysis; Future care; Palliative care
Categories
Funding
- Danish Cancer Society
- TrygFonden
- The Danish Cancer Society [R82-A5134] Funding Source: researchfish
Ask authors/readers for more resources
Objective: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor patient interactions. Method: Following a discourse-analysis approach, the study uses the concept of doctor and patient voices to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark. Results: Previous studies of directly observed patient-physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance. Significance of Results: Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available