Emotionally reflexive labour in end-of-life communication

Olson, Rebecca E.; Smith, Alexandra; Good, Phillip; Neate, Emily; Hughes, C.; Hardy, Janet

doi:10.1016/j.socscimed.2020.112928

Cited by 19 publications

(17 citation statements)

References 42 publications

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“… 21 However, many clinicians worry that words like die , death , or dying may be perceived as harsh 16 and prefer to match the language used by patients and families. 17 , 49 Our design did not allow for direct assessment of family preferences, including whether acknowledging death using the word itself a single time or mirroring the language used by family members is sufficient. Given that we found that most references to death made by family members were euphemistic, future work should prioritize assessing family preferences for language use.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the Language Used to Discuss Death in Family Meetings for Critically Ill Infants

et al. 2022

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ImportanceCommunication during conversations about death is critical; however, little is known about the language clinicians and families use to discuss death.ObjectiveTo characterize (1) the way death is discussed in family meetings between parents of critically ill infants and the clinical team and (2) how discussion of death differs between clinicians and family members.Design, Setting, and ParticipantsThis longitudinal qualitative study took place at a single academic hospital in the southeast US. Patients were enrolled from September 2018 to September 2020, and infants were followed up longitudinally throughout their hospitalization. Participants included families of infants with neurologic conditions who were hospitalized in the intensive care unit and had a planned family meeting to discuss neurologic prognosis or starting, not starting, or discontinuing life-sustaining treatment. Family meetings were recorded, transcribed, and deidentified before being screened for discussion of death.Main Outcomes and MeasuresThe main outcome was the language used to reference death during family meetings between parents and clinicians. Conventional content analysis was used to analyze data.ResultsA total of 68 family meetings involving 36 parents of 24 infants were screened; 33 family meetings (49%) involving 20 parents (56%) and 13 infants (54%) included discussion of death. Most parents involved in discussion of death identified as the infant’s mother (13 [65%]) and as Black (12 [60%]). Death was referenced 406 times throughout the family meetings (275 times by clinicians and 131 times by family members); the words die, death, dying, or stillborn were used 5% of the time by clinicians (13 of 275 references) and 15% of the time by family members (19 of 131 references). Four types of euphemisms used in place of die, death, dying, or stillborn were identified: (1) survival framing (eg, not live), (2) colloquialisms (eg, pass away), (3) medical jargon, including obscure technical terms (eg, code event) or talking around death with physiologic terms (eg, irrecoverable heart rate drop), and (4) pronouns without an antecedent (eg, it). The most common type of euphemism used by clinicians was medical jargon (118 of 275 references [43%]). The most common type of euphemism used by family members was colloquialism (44 of 131 references [34%]).Conclusions and RelevanceIn this qualitative study, the words die, death, dying, or stillborn were rarely used to refer to death in family meetings with clinicians. Families most often used colloquialisms to reference death, and clinicians most often used medical jargon. Future work should evaluate the effects of euphemisms on mutual understanding, shared decision-making, and clinician-family relationships.

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Section: Discussionmentioning

confidence: 99%

Characterizing the Language Used to Discuss Death in Family Meetings for Critically Ill Infants

et al. 2022

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“…Clinical work – especially doctoring – is sometimes presented as a practice which is ideally conducted in a state of ‘medical objectivity’, free from the compromising impacts of emotions, and overriding cultural instincts and values (Cook, 2014; Lupton, 2012; Scott, 2000; Whyte et al., 2002). However, in some medical specialities, emotions are a more obvious feature of clinical work, and clinicians are expected to reflexively manage and communicate emotions, such as supporting patients and their families with death and dying (Olson et al., 2020). Beyond managing emotions for effective communication and supporting patients, affect and emotion are arguably ubiquitous features of clinical practice (Scott, 2000).…”

Section: Introductionmentioning

confidence: 99%

Prescribing as affective clinical practice: Transformations in sexual health consultations through HIV pre‐exposure prophylaxis

Smith

Newman

Haire

et al. 2022

Sociology Health & Illness

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New medicines can transform routines and priorities in clinical practice, but how do clinicians think and feel about these changes, and how does it affect their work? In Australia, the HIV prevention regimen pre‐exposure prophylaxis (PrEP) has been rapidly rolled out, transforming the sexual cultures and practices of users, but less attention has been given to the ways PrEP has reconfigured clinical practice. This paper draws on 28 qualitative semi‐structured interviews conducted between 2019 and 2020 with PrEP‐providing doctors and nurses in Australia to consider how they have affectively engaged with PrEP and put it into practice. Through a reflexive thematic analysis, we explore how clinicians adapted to PrEP, how the field of HIV prevention has been transformed, and how these developments have changed how clinicians approach patients. While the introduction of PrEP was initially received with uncertainty and shock, clinicians described PrEP as enjoyable to prescribe, and better aligned with the moral duties of sexual health consultations than existing HIV prevention strategies like condoms. Through approaching clinical work as an ‘affective practice’, we argue for attending not only to how new interventions change expectations and practices, but also how these changes are felt and valued by clinicians.

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“…As in earlier reports (Olson et al, 2021), staff acknowledged challenges in managing their own emotions and those of FCs during endof-life communication. End-of-life communication was particularly demanding for NH nurses, who often represent FCs' main point of contact for discussing prognosis.…”

Section: Corporealitymentioning

confidence: 80%

Lived experiences of end‐of‐life communication among nursing home staff: An interpretive phenomenological study

Gonella

Conti²,

Albanesi³

et al. 2022

Journal of Advanced Nursing

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Aims:To explore and understand lived experiences of end-of-life communication among nursing home staff.Design: Interpretive phenomenological study. Methods:In-person, semi-structured, in-depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end-of-life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research.Results: Thirteen categories were identified and framed within the four existentials.Regarding spatiality, end-of-life communication took place in a physical, mental, socio-cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end-of-life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end-of-life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. Conclusion:End-of-life communication was an all-encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end-of-life.

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Emotionally reflexive labour in end-of-life communication

Cited by 19 publications

References 42 publications

Characterizing the Language Used to Discuss Death in Family Meetings for Critically Ill Infants

Characterizing the Language Used to Discuss Death in Family Meetings for Critically Ill Infants

Prescribing as affective clinical practice: Transformations in sexual health consultations through HIV pre‐exposure prophylaxis

Lived experiences of end‐of‐life communication among nursing home staff: An interpretive phenomenological study

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