Possible age-related differences in healthcare professionals’ perspectives on younger and older patients’ autonomy and decision-making in the context of sedation in specialised palliative care: exploratory secondary qualitative content and linguistic conversation analysis of interviews with healthcare professionals

Kurkowski, Sandra; Heckel, Maria; Larissa, Pfaller; Peters, Joachim; Bazata, Jeremias; Schildmann, Eva; Christoph, Ostgathe

doi:10.1186/s12904-022-00963-y

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…Past research has found professionals' perceptions of dignity to depend on diverse factors, including their country of origin, medical specialty, clinical experience, religion, philosophy (Morita et al, 2015), patient age (Kurkowski et al, 2022), and culture (Butkevičienė et al, 2021). However, how they are embedded in specific care models has rarely been examined.…”

Section: Healthcare Professionals' Perceptions Of Eol Dignitymentioning

confidence: 99%

Dignity in Action in the Home Hospice: The Narrative Selection of a Multidisciplinary Staff

Spector-Mersel

Yakov

2023

Qual Health Res

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Home hospice (HH) is a palliative care framework that is becoming more and more common in Western countries. HH staff face unique challenges, resulting mainly from their multiple clients and the provision of care in a private territory. Despite the recognized role of professionals in preserving end-of-life (EOL) dignity, how HH staff conceive of EOL dignity has remained unexplored. To fill this lacuna, we invited the multidisciplinary staff of an Israeli HH to recount unguided narratives of dignity and indignity in the HH. We analyzed the mechanisms of narrative selection in each story and in the entire dataset, particularly regarding two dimensions of dignity: situation—whether the recounted cases present dignity, indignity, or both; and relations—who provides (in)dignity to whom. The analysis revealed four interconnected end-points: HH is a dignity-providing framework; HH staff provide and promote dignity; HH dignity as relations and communication; and HH dignity as a holistic process whose boundaries are expanded and blurred, both spatially and temporally. The differences between these and other findings on healthcare professionals’ perspectives of EOL dignity highlight the uniqueness of HH staff, and possibly the distinctiveness of the Israeli case with its traditional familial values. Importantly, the findings were generated due to the narrative paradigm guiding the study. The unique attributes of the narrative text enabled us to capture the dynamic temporal nature of dignity-in-action, as embedded in the staff’s daily practice. Implications for training professionals to preserve EOL dignity in HH and other EOL care frameworks are discussed.

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Section: Healthcare Professionals' Perceptions Of Eol Dignitymentioning

confidence: 99%

Dignity in Action in the Home Hospice: The Narrative Selection of a Multidisciplinary Staff

Spector-Mersel

Yakov

2023

Qual Health Res

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“…Following the publication of the original article [ 1 ], the author reported that the given name and family name of all authors were erroneously transposed.…”

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confidence: 99%

Correction: Possible age-related differences in healthcare professionals’ perspectives on younger and older patients’ autonomy and decision-making in the context of sedation in specialised palliative care: exploratory secondary qualitative content and linguistic conversation analysis of interviews with healthcare professionals

et al. 2022

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“It is very hard to just accept this” – a qualitative study of palliative care teams’ ethical reasoning when patients do not want information

Björk

2024

BMC Palliat Care

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Background The aim of this study was to explore how palliative care staff reason about the autonomy challenge that arises when a patient who has first said he wants full information appears to change his mind and rejects being informed. Methods The study had a qualitative and exploratory design. Participants (physicians, registred nurses, social workers, physiotherapists and occupational therapists) were recruited from palliative care teams in southern Sweden. Six separate focus group interviews with a total number of 33 participants were conducted. The teams were asked to discuss a fictional case of a man who first wants, then rejects, information about his situation. The interviews were audiotaped and transcribed verbatim. Reflexive thematic analysis following Braun and Clarke was undertaken to analyse data. Results The analysis resulted in three themes: Patients have a right to reject information, Questioning whether this patient WANTS to reject information and There are other values at stake, too. Although participants endorsed a right to reject information, they were unsure whether this right was relevant in this situation, and furthermore felt that it should be balanced against counteracting factors. The effect of such balancing was that participants would aim to find a way to present relevant information to the patient, but in a probing and flexible way. Conclusions In their work with dying patients, palliative care staff meet many autonomy challenges. When faced with a choice to withhold information as per a patient’s wishes, or to provide information with the patient’s best interest in mind, staff find it hard to balance competing values. Staff also find it hard to balance their own interests against a purely professional stance. The overall strategy seems to be to look for caring ways to impart the information.

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Cited by 4 publications

References 24 publications

Dignity in Action in the Home Hospice: The Narrative Selection of a Multidisciplinary Staff

Dignity in Action in the Home Hospice: The Narrative Selection of a Multidisciplinary Staff

“It is very hard to just accept this” – a qualitative study of palliative care teams’ ethical reasoning when patients do not want information

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