Integrating Palliative Care: A Postmodern Perspective

Zimmermann, Camilla; Wennberg, Richard

doi:10.1177/1049909106290242

Cited by 15 publications

(10 citation statements)

References 26 publications

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“…In drawing attention to another binary opposition, almost 20 years ago, James and Field (1992) warned of the unintended consequences that may follow as palliative care became 'routinised' and (re)incorporated into the mainstream, noting that the root strength of the hospice movement as originally conceptualised by Saunders and colleagues was its specific focus on the care of the terminally ill cancer patient. It is now time to move beyond these and the other dichotomies (for example, 'comfort' versus 'cure') that have been so characteristic of palliative care in the twentieth century (Zimmerman & Wennberg, 2006) so that the benefits of palliative and end-of-life care reach the rapidly increasing and diverse groups of people in need. This paper has used the evolution of English palliative and end-oflife care policy as a case study to illustrate the complex factors which need to be addressed to effect this transformation.…”

Section: Conclusion: Forecasting the Futurementioning

confidence: 97%

Looking back, looking forward: the evolution of palliative and end-of-life care in England

Seymour

2012

Mortality

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Palliative and end-of-life care in England has undergone some remarkable transformations across the course of less than half a century and can be seen as a useful case study with which to understand international trends and challenges. This paper examines some of the long term influences which led to the emergence, for the very first time, of an End-of-Life Care Strategy in England. It revisits the critical contribution of Cicely Saunders to the development of a theoretical framework for palliative care before examining the gradual and as yet incomplete transformation of 'palliative care' into 'end-of-life care' which is occurring internationally. The paper then turns to examine two key challenges in contemporary end-of-life care, looking at how these are being addressed in England and forecasting the possible direction of travel in the future.

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Section: Conclusion: Forecasting the Futurementioning

confidence: 97%

Looking back, looking forward: the evolution of palliative and end-of-life care in England

Seymour

2012

Mortality

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“…Death anxiety has been found to be common in patients with advanced cancer (18) and its relief may be considered a primary goal of palliative care in this population (19). Death anxiety has been associated with negative outcomes, including impaired quality of life and psychiatric comorbidities such as depression and generalized anxiety (20,21).…”

Section: Introductionmentioning

confidence: 99%

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

Shaw

Chrysikou

Davis

et al. 2017

Patient Education and Counseling

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How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Aim: To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this self-reported symptom and its clinical presentation. Design: Participants were part of a psychotherapy trial in advanced cancer. First therapy session transcripts were analyzed using interpretive description in patients reporting low, moderate and high death anxiety on the Death and Dying Distress Scale (DADDS). Setting/participants: 16 participants (10 women and 6 men) with advanced or metastatic cancer were recruited at The Princess Margaret Cancer Centre, Toronto, Canada. In this sample, 6 reported low death anxiety scores (DADDS 0-19), 5 moderate (DADDS 20-50), and 5 high (DADDS 51-75). Results: The low death anxiety group exhibited psychological readiness for death, or contrastingly, non-reflectiveness about death. The moderate group recognized the imminence of mortality, which impacted treatment decisions and future plans. Prior experience with death was discussed as raising the salience of mortality. The high group felt dominated by powerful emotions and could not make sense of their situation. Their distress was exacerbated by substantial relational concerns. Conclusions: Self-reported death anxiety is affected by the awareness and ability to reflect on mortality. DADDS scores may facilitate exploration of this symptom as part of a clinical assessment and may serve to guide treatment approaches. Greater attention to death anxiety is consistent with and recommended by contemporary approaches to palliative care.

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“…This idea, that family medicine, which is associated with whole-person care, is somehow less than specialties that are more disease-focused, reinforces the idea that the patient-centered, care-based approach is less valuable than the disease-focused, cure-based approach. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model (De Valck et al 2001 ; Zimmermann and Wennberg 2006 ).…”

Section: Dichotomous Languagementioning

confidence: 99%

The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine

Choudhury

Nortjé

2020

HEC Forum

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Although current literature about the "cure versus care" issue tends to promote a patient-centered approach, the disease-centered approach remains the prevailing model in practice. The perceived dichotomy between the two approaches has created a barrier that could make it difficult for medical students and physicians to integrate psychosocial aspects of patient care into the prevailing disease-based model. This article examines the influence of the formal and hidden curricula on the perception of these two approaches and finds that the hidden curriculum perpetuates the notion that "cure" and "care" based approaches are dichotomous despite significant changes in formal curricula that promote a more integrated approach. The authors argue that it is detrimental for clinicians to view the two approaches as oppositional rather than complementary and attempt to give recommendations on how the influence of the hidden curriculum can be reduced to get a both-cure-and-care-approach, rather than an either-cure-or-care-approach.

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Integrating Palliative Care: A Postmodern Perspective

Cited by 15 publications

References 26 publications

Looking back, looking forward: the evolution of palliative and end-of-life care in England

Looking back, looking forward: the evolution of palliative and end-of-life care in England

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

The Hidden Curriculum and Integrating Cure- and Care-Based Approaches to Medicine

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