Communicative practices in talking about death and dying in the context of Thai cancer care

Abstract

This article explores communicative practices surrounding how nurses, patients and family members engage when talking about death and dying, based on study conducted in a province in northern Thailand. Data were collected from three environments: a district hospital (nine cases), district public health centres (four cases), and in patients’ homes (27 cases). Fourteen nurses, 40 patients and 24 family members gave written consent for participation. Direct observation and in-depth interviews were used for supplementary data collection, and 40 counselling sessions were recorded on video. The raw data were analysed using Conversation Analysis. The study found that Thai counselling is asymmetrical. Nurses initiated the topic of death by referring to the death of a third person – a dead patient – with the use of clues and via list-construction. As most Thai people are oriented to Buddhism, religious support is selected for discussing this sensitive topic, and nurses also use Buddhism and list-construction to help their clients confront uncertain futures. However, Buddhism is not brought into discussion on its own, but combined with other techniques such as the use of euphemisms or concern and care for others.

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

“…Niedel et al (2013) show that the development of parents' understanding of the illness (diabetes) of their child is visible in the organization of their interactions with nurses. Announcing (imminent) death to patients and relatives requires much interpersonal effort, deployed to alleviate suffering of the conversational partner (Wilainuch, 2013). These situations focus more on the recipients' feelings and less on clinical matters.…”

“…This happens when they initiate discussions about death to inform and provide emotional support (Wilainuch, 2013), when they use humor to reduce patients' anxiety (Mallett and A'hern, 1996) and foster optimism in cancer patients (Jarrett and Payne, 2000). Nurses readily display empathy at the patients' home (Adams, 2001b).…”