Anderson2020
| Anderson2020 | |
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| BibType | PHDTHESIS |
| Key | Anderson2020 |
| Author(s) | Rebecca Jade Anderson |
| Title | Communication with the relatives and friends of imminently dying patients in a hospice |
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| Tag(s) | EMCA, Hospice, Medical, Family |
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| Year | 2020 |
| Language | English |
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| URL | Link |
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| School | University College London |
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Abstract
Communication between healthcare professionals and the relatives and friends of patients who are imminently dying is a key part of providing high quality end-of-life care. The primary aim of this thesis is to understand the practices used to accomplish prognostication and other relevant activities in these conversations. This aim is addressed by audio-recording 29 conversations between senior, experienced healthcare professionals and the relatives and friends of terminal-care patients in a hospice. Conversation analysis of recordings is used to identify interactional practices within these conversations. Three conversation analytic chapters explore terminal-phase prognostication sequences; closing the business-at-hand (exiting prognostic talk and transitions towards closings); and disagreements. These chapters demonstrate how healthcare professionals and relatives navigate the uncertainty which is inherent in end-of-life talk. They show how participants discuss potentially difficult topics and transition towards more certain talk on topics that allow an orientation towards action. A secondary aim is to understand the perspectives of healthcare professionals and the relatives and friends of patients about what is important during communication with families at the end of life. This is addressed by interviewing 12 bereaved relatives and friends, and conducting a focus group and interview with five healthcare professionals. Thematic analysis identifies contextual factors such as hospice facilities and privacy that can impact experiences of communication, as well as more specific elements of communication that participants consider important, such as honesty about uncertainty and consultation during decision making. The final aim is to provide recommendations for training to improve communication skills for less experienced healthcare professionals. This is addressed by combining the conversation analytic findings with the thematic analysis to give a comprehensive understanding of communication in this context. Recommendations for communication practices to be taught within a training programme are presented, alongside suggestions for the additional work required to implement training in practice.
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