Contextualisation of patient-centred care: A comparative qualitative study of healthcare professionals' approaches to communicating with seriously ill patients about their dependent children

Abstract

Patients' family relations play an important part in the provision of patient-centred cancer care, not least when healthcare professionals encounter seriously ill patients with dependent children. Little is known about how children are perceived and dealt with in clinical encounters. In this qualitative comparative study, we explore the influence of medical contexts in three Danish hospital wards, haematology, oncological gynaecology and neuro-intensive care, on communication with patients about their children. In exploring the degree to which the inclusion of children in clinical encounters is dependent on context, we took a comparative approach based on fieldwork in wards either exclusively focusing on cancer treatment or partially involved in critical phases of cancer treatment. We conducted 49 semi-structured, in-depth interviews with doctors and nurses, and 27 days of participant observation. The thematic analysis was based on Bateson's conceptualisation of communication. We found that healthcare professionals' approach to children in clinical encounters and the ways in which children were positioned on each ward were influenced by aspects specific to the ward, including the diagnosis and treatments that related specifically to the patient. Our findings suggest the need to explore further the influence of medical contexts on the inclusion of children in patient communication. K E Y W O R D Scancer, comparative study, families with dependent children, intensive care units, patientcentred care, qualitative research

The Divorced Family–Focused Care Model: A Nursing Model to Enhance Child and Family Mental Health and Well-Being of Doubly Bereaved Children Following Parental Divorce and Subsequent Parental Cancer and Death

“…Like our study, Nilsson and colleagues arrived at the clinical implication showing that nurses should provide additional adequate support to the patients with dependent children. Our study findings also concur with Nilsson et al’s and other studies, indicating that additional nursing psychosocial interventions are needed to plan adequately for the patient’s relative children and their future needs (Dencker, Kristiansen, Rix, Boge, & Tjornhoj-Thomsen, 2018; Nilsson et al, 2009).…”

“…This study concurs with research by others that highlights the importance of nursing work in collecting relevant, timely, and holistic family information that can be used to develop care plans (Dencker et al, 2018;Gordon et al, 1999), in particular, to assist in supporting and drawing together the combined capacity of divorced families, including noncustodial parents and other relatives such as stepparents and grandparents in cooperation around child well-being and future (Bugge et al, 2008(Bugge et al, , 2009Reiter et al, 2013). Our research found that it is important to create opportunities to assess the child and initiate well-being support and care provision for the child's actual and potential psychosocial needs in an effort to prevent future problems.…”

Smart, vulnerable, playful or just disturbing? A discourse analysis of child involvement in palliative care

“…In line with previous studies that found that the conditions of the medical context limit health professionals’ possibilities to involve children (Dencker et al, 2017a; Karidar et al, 2016), our analysis indicates that the palliative context might contribute to health professionals viewing the child from ‘outside’. This objectified view limits the health professionals’ possibility to empathically tune into children and see them as experiencing subjects when in the palliative context (Sommer et al, 2013).…”

“…The patient-centred palliative care ideology legitimizes involving children (Dencker et al, 2017a) by inviting them to stay in the hospital insofar as it contributes to the well-being of the patient, and not if it disturbs the patient. In the same vein, the ruling medical logic defines the doctor’s job as most important, and the young, active child should not disturb the doctor in delivering medical treatment.…”

“…Studies exploring health professionals’ perspectives show some interesting findings with regard to perceived barriers to gaining the ideal support from health professionals. Several Scandinavian studies point towards emotional and structural barriers that make it challenging for health professionals to involve and support the minor children of their patients (Dencker et al, 2017a, 2017b; Golsäter et al, 2016; Karidar et al, 2016; Ruud et al, 2015). Emotional barriers consist of health professionals’ experienced distress in encounters with children and death, which might lead to withdrawal or professional distance (Dencker et al, 2017b; Golsäter et al, 2016).…”