Multidisciplinary Clinicians and the Relational Autonomy of Persons with Neurodegenerative Disorders and an Advance Care Plan: A Thematic Analysis

Craig, Denise; Ray, Robin; Harvey, Desley; Shircore, Mandy

doi:10.2147/jmdh.s345792

Cited by 3 publications

(1 citation statement)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings presented in this paper constitute part of constructivist grounded theory research exploring enablers and barriers to hospital doctors’ application of ACPs of incapacitated patients with neurodegenerative disorder (see separately published results). 19 , 24 Consistent with the constructivist grounded theory methodology, this research commenced with broad aims rather than specific objectives. This paper provides a thematic analysis explaining how system factors potentially influence doctors’ application of ACPs to public hospital healthcare decision-making.…”

Section: Methodsmentioning

confidence: 99%

Doctor’s Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis

Craig,

Ray

2024

JMDH

Self Cite

View full text Add to dashboard Cite

Context Healthcare consumers are encouraged to develop an Advance Care Plan (ACP) to help to ensure their preferences are known and respected. However, the role of governing systems in the application of ACPs must be understood if patients’ voices (expressed within this medium) are to be heard. Objective To explore systemic barriers influencing Queensland public hospital doctors’ application of the Advance Care Plans of hospitalized people with a neurodegenerative disorder. Methods Using a constructivist grounded theory approach, 16 semi structured interviews were conducted with public hospital doctors. Data were inductively analysed using open and focused coding. Results Analysis revealed two main themes: Practicing Medicine within a Legal Construct, and Delegitimizing ACP. Participants found the application of ACP in Queensland unduly complex, and they were inadequately prepared by education or training. Doctors maintained a dominant role in temporal medical decision-making and cited hospital practice culture for delegitimizing patient-owned ACPs. Conclusion The public healthcare system in Queensland exerts considerable influence over the degree to which ACPs influence decision-making. Despite the premise that ACPs give patients a powerful voice, hospital doctors often do not understand the underpinning law on which they depend when citing their responsibility for good medical practice. Systemic influences have contributed to a practice culture that has delegitimized the patient’s voice when expressed through an ACP.

show abstract

Section: Methodsmentioning

confidence: 99%

Doctor’s Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis

Craig,

Ray

2024

JMDH

Self Cite

View full text Add to dashboard Cite

show abstract

The role of law in end-of-life decision-making in emergency departments and intensive care units: a retrospective review of current practice in a Queensland health service

Hewitt,

Alsaba,

May

et al. 2023

Aust. Health Rev.

View full text Add to dashboard Cite

Objective There is limited evidence about how legal frameworks that underpin end-of-life decisions are applied in practice. This study aimed to identify how end-of-life decisions are made and documented in emergency departments and intensive care units. The secondary aim was to explore the extent to which the legal processes featured in these decisions. Methods A retrospective chart audit of 85 adult patients who died in the emergency departments and intensive care units of a Queensland health service was undertaken. Quantitative data were analysed and reported using descriptive statistics. Qualitative textual data were analysed using inductive content analysis. Results Nearly all admissions were unplanned (97.6%), and most patients (74.1%) were admitted from home. Only one patient had an advance health directive, although all had an eligible substitute decision-maker. The qualitative analysis revealed two main concepts – ‘healthcare professionals choreograph the end of life’ and ‘patients and families are carried on an unplanned journey’. Conclusions There was limited documentation related to the application of the legal framework in these decisions. Healthcare professionals relied on their clinical judgment about what was in the best interest of the patient. It was common for there to be a substantial effort to achieve consensus in decision-making which coincidently complied with the law.

show abstract

Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis

Le,

Lin,

Huang

et al. 2023

Nurs Ethics

View full text Add to dashboard Cite

Background Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. Objective The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. Methods A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. Results 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual’s relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers’ dominant voice hampers the demonstration of relational autonomy. Conclusions Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual’s values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual’s values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.

show abstract

Multidisciplinary Clinicians and the Relational Autonomy of Persons with Neurodegenerative Disorders and an Advance Care Plan: A Thematic Analysis

Cited by 3 publications

References 39 publications

Doctor’s Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis

Doctor’s Perceptions of the Systemic Influences on Advance Care Plan Application: A Thematic Analysis

The role of law in end-of-life decision-making in emergency departments and intensive care units: a retrospective review of current practice in a Queensland health service

Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis

Contact Info

Product

Resources

About