Ekberg-etal2017

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Ekberg-etal2017
BibType ARTICLE
Key Ekberg-etal2017
Author(s) Stuart Ekberg, Susan Danby, Anthony Herbert, Natalie K. Bradford, Patsy Yates
Title Affording opportunities to discuss deterioration in paediatric palliative care consultations: A conversation analytic study
Editor(s)
Tag(s) EMCA, Palliative care, Medical EMCA, Medical EMCA
Publisher
Year 2017
Language
City
Month
Journal BMJ Supportive & Palliative Care
Volume
Number
Pages
URL Link
DOI 10.1136/bmjspcare-2016-001130
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

Objective

Discussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations.

Methods

Nine consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised.

Findings

The study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration:

1) soliciting the family’s agenda for the consultation;

2) initiating and maintaining topics where discussing deterioration is a relevant possibility.

Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur.

Conclusions

These communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a child’s family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.

Notes