Barriers to communication regarding end-of-life care: perspectives of care providers

Anselm, Anjali; Palda, Valerie A.; Guest, Cameron B.; McLean, R F; Vachon, Mary L. S.; Kelner, Merrijoy; Lam-McCulloch, Jenny

doi:10.1016/j.jcrc.2005.05.012

Cited by 58 publications

(73 citation statements)

References 34 publications

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“…63 Furthermore, many physicians worry about known inaccuracies in physician prognostication and prognostic uncertainty, and therefore withhold information until the patient is so close to death that accuracy is assured. 53,64 Even when discussions are held, a truthful assessment of their prognosis is often not given. 65,66 Although physician estimates of prognosis are more accurate than patient estimates, 67,68 physicians often communicate an overly optimistic prognosis, or only provide vague statements without a specific time estimate, even in patients who express a desire to hear the truth.…”

Section: Communicating Prognosismentioning

confidence: 99%

“…191 In addition, many physicians report that they do not have enough time to discuss important topics with their patients, including DNR discussions. 33,64,192 As a result of this lack of communication, some patients who do not desire it experience attempted resuscitation. 193 Discussions of code status have many of the same elements as discussing prognosis and bad news.…”

Section: Do-not-resuscitate (Dnr) Ordersmentioning

confidence: 99%

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Communication Strategies and Cultural Issues in the Delivery of Bad News

Barclay

Blackhall

Tulsky

2007

Journal of Palliative Medicine

129

123

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Good communication is a fundamental skill for all palliative care clinicians. Patients present with varied desires, beliefs, and cultural practices, and navigating these issues presents clinicians with unique challenges. This article provides an overview of the evidence for communication strategies in delivering bad news and discussing advance care planning. In addition, it reviews the literature regarding cultural aspects of care for terminally ill patients and their families and offers strategies for engaging them. Through good communication practices, clinicians can help to avoid conflict and understand patients' desires for end of life care.

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Section: Communicating Prognosismentioning

confidence: 99%

Section: Do-not-resuscitate (Dnr) Ordersmentioning

confidence: 99%

Communication Strategies and Cultural Issues in the Delivery of Bad News

Barclay

Blackhall

Tulsky

2007

Journal of Palliative Medicine

129

123

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“…En la intervención con los familiares, lo que los psicólo-gos consideran más problemático coincide con lo destacado por otros estudios en equipos de cuidados paliativos: la existencia de psicopatología previa en los familiares y el paciente (Lichtenthal y Kissane, 2008), las grandes demandas de las familias (Anselm et al, 2005;Lichtenthal y Kissane, 2008), o la llamada obsesión terapéutica, que tiene que ver con la dificultad para suspender las medidas de carácter curativo (Mialdea et al, 2009). Durante las entrevistas se ha detectado en algunos psicólogos una cierta tolerancia hacia la llamada conspiración de silencio (Schmidt Río-Valle et al, 2009;Schmidt Río-Valle, Montoya-Juárez, García-Caro, y CruzQuintana, 2008).…”

Section: Discussionunclassified

Experiencias y obstáculos de los psicólogos en el acompañamiento de los procesos de fin de vida

et al. 2013

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Resumen: Los psicólogos están encargados de realizar la atención emocional a los pacientes que se encuentran en procesos de fin de vida. No se conocen cuáles son las experiencias, los obstáculos y problemas con que se encuentran al intervenir en estos casos, siendo éste el principal objetivo de la investigación. Para ello se realizó un estudio cualitativo de tipo fenomenológico utilizando entrevistas en profundidad, que se analizaron con el software Atlas.ti siguiendo una codificación abierta. La muestra estuvo compuesta por 15 psicólogos que desempeñaban su labor en cuidados paliativos, otras unidades hospitalarias (oncología, salud mental, urgencias y atención temprana) o intervenían de manera privada en la provincia de Granada (España). Los resultados muestran la variedad de experiencias en esta intervención, así como la existencia de diferentes obstáculos que dependen del momento de intervención, de las características propias del paciente o la familia, las emociones del psicólogo, o la organización sanitaria. Se ponen de relevancia cómo los propios sentimientos de los psicólogos pueden influir en su intervención, y se propone la necesidad de una formación para superar los diferentes obstáculos que plantea la intervención en el final de vida. Palabras Clave: psicología; estudio cualitativo; profesionales de la salud; enfermedad terminal; cuidados paliativos.Title: Experiences and obstacles of psychologists in the accompaniment of end-of-life processes. Abstract: Psychologists are responsible for the emotional care to patients who are in end-of-life processes. Little is known about the experiences, the obstacles and problems they face when addressing such complex situations, so the main objective of this research is to understand and explore what they are. A qualitative phenomenological design was performed, using semi structured interviews, which were analyzed with the software Atlas.ti following an open coding. The sample consisted of 15 psychologists who perform their work in palliative care, other hospital units (oncology, mental health, emergency and early intervention) or privately involved in the province of Granada (Spain). The results show how psychologists contact with patients in end-of-life processes, as well as the variety of both positive and negative experiences in their speech. It is shown the existence of various obstacles that have to do with the timing of intervention, characteristics of the patient or family, with the emotions of the psychologist, as well as the health organization. This study shows how the feelings of the psychologists can influence their intervention, which raises the need for a specific training where they can learn different strategies to overcome the obstacles posed by intervention at the end-of-life. Keywords: psychology; qualitative study; health professionals; terminal illness; palliative care. IntroducciónSegún el American National Institute Health el proceso de fin de vida está formado por una serie de componentes (Ostgathe y Voltz, 2010). Estaríamos ante la pres...

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“…These barriers can be allocated into four main groups: (1) patients and families, (2) health professionals, (3) the structure of the medical care system (Hickman, 2002;Larson & Tobin, 2000), and (4) the nature of the end-of-life communication dialogue (Anselm et al, 2005). Although effective interventions need to target all of these components, the barriers associated with health professionals seem to be most crucial, because they directly compromise the patient-doctor interaction (Curtis et al, 2000).…”

Section: End-of-life Care: Communication Challenges and Opportunitiesmentioning

confidence: 99%

Physician-Perceived Contradictions in End-of-Life Communication: Toward a Self-Report Measurement Scale

Amati

Hannawa

2014

Health Communication

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Communication is undoubtedly a critical element of competent end-of-life care. However, physicians commonly lack communication skills in this particular care context. Theoretically grounded, evidence-based guidelines are needed to enhance physicians' communication with patients and their families in this important time of their lives. To address this need, this study tests and validates a Contradictions in End-of-Life Communication (CEOLC) scale, which disentangles the relational contradictions physicians commonly experience when communicating with end-of-life patients. Exploratory factors analysis confirmed the presence of eight physician-perceived dialectical tensions, reflecting three latent factors of (1) integration, (2) expression, and (3) dominance. Furthermore, a number of significant intercultural differences were found in cross-cultural comparisons of the scale in U.S., Swiss, and Italian physician samples. Thus, this investigation introduces a heuristic assessment tool that aids a better understanding of the dialectical contradictions physicians experience in their interactions with end-of-life patients. The CEOLC scale can be used to gather empirical evidence that may eventually support the development of evidence-based guidelines and skills training toward improved end-of-life care.

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Barriers to communication regarding end-of-life care: perspectives of care providers

Cited by 58 publications

References 34 publications

Communication Strategies and Cultural Issues in the Delivery of Bad News

Communication Strategies and Cultural Issues in the Delivery of Bad News

Experiencias y obstáculos de los psicólogos en el acompañamiento de los procesos de fin de vida

Physician-Perceived Contradictions in End-of-Life Communication: Toward a Self-Report Measurement Scale

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