Negotiating the turning point in the transition from curative to palliative treatment: a linguistic analysis of medical records of dying patients

Abstract

Background Many deaths in Norway occur in medical wards organized to provide curative treatment. Still, medical departments are obliged to meet the needs of patients at the end of life. Here, we analyse the electronic patient record regarding documentation of the transition from curative to palliative care (i.e. the ‘turning point’). Considering the consequences of these decisions for patients, they have received surprisingly little attention from researchers. This study aims to investigate how the patient record denotes reasons for the shift from curative treatment to palliation and how texts involve voices of the patient and their families. Methods The study comprised excerpts from electronic patient records retrieved from medical wards in three urban hospitals in Norway. We executed a retrospective analysis of anonymized extracts from 16 electronic patient records, searching for documentation on the transition from curative to palliative care. Results In the development of the turning point, the texts usually shift from statements about the patient’s clinical status and technical findings to displaying uncertainty and openness to negotiation with different textual voices. This shift may represent a need to align or harmonize the attitudes of colleagues, family, and patient towards the turning-point decision. The patient’s voice is mostly absent or reported only briefly when, in their notes, nurses gave an account of the patient’s opinion. None of the physicians’ notes provided a detailed account of patient attitudes, wishes, and experiences. Conclusion In this article, we have analysed textual representations of patient transitions from curative to end-of-life care. The ‘reality’ behind the text has not been our concern. As the only documentation left, the patient record is an adequate basis for considering how patients are estimated and cared for in their last days of life.

Experiences of Patients with Advanced Chronic Disease Transitioning to Palliative Care in Low- and Middle-Income Countries: A Scoping Review

“…[1,2] Palliative care is not about curing the chronic illness but about making the patient as comfortable as possible and helping them to live a full and meaningful life, while curative care focuses on eradicating the illness and restoring the patient to full health. [3] Palliative care (PC) is a crucial part of achieving universal health coverage. Highincome countries offer effective palliative care interventions, allowing people with serious illnesses to live fully, while palliative care access is often limited in low-income and Middle countries due to a lack of awareness, cultural beliefs, limited services, and inadequate access to opioid pain relief.…”

Prevalence and predictors for 72-h mortality after transfer to acute palliative care unit

“…Approaching end-of-life (EoL) can be challenging for patients, relatives, nurses, and treating physicians alike [ 1 ]. Discussing when best to pivot from potentially life-prolonging therapy to palliative care may be complex, yet such topics should be on the agenda ideally earlier rather than later during the course of a life-limiting disease [ 2 ]. Often framed as advance care planning (ACP), these conversations may address goal of care, cardiopulmonary resuscitation, artificial nutrition, antibiotics, transfer to intensive care unit and acute palliative care units (APCUs), advance care directives, last will, last place of care and place of death [ 3 , 4 ].…”

What are dually diagnosed patients’ problems represented to be in mental health? A WPR analysis of the multistability purpose of digital health records

“…Especially within nursing research, the constitution and written communication of/in health‐care records have been scrutinised (Ameel et al., 2020; Hamilton & Manias, 2006; Heartfield, 1996; Hyde et al., 2005; Moerenhout et al., 2020; Mohr, 1999; Zabielska, 2021). Most of this research primarily draws on a Foucauldian framework (Ameel et al., 2020; Hamilton & Manias, 2006; Heartfield, 1996; Hyde et al., 2005, 2006; Irving et al., 2006; Mohr, 1999), Habermas (Hyde et al., 2005) or linguistic theories (Berring et al., 2015; Hov et al., 2020). Recent research tends to draw more on post‐phenomenological theory and perspectives from science and technology studies (STS) to consider how digital records become actants that can bring into effect various issues such as concerns about professionalism or systemic rights violations following the technologies’ capacity to serve multiple purposes (de Boer, 2021; Moerenhout et al., 2020).…”