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Mei X, Tu J. Maneuvering between cultures: The reception of hospice care in the Chinese medical community. Soc Sci Med 2024; 357:117186. [PMID: 39121566 DOI: 10.1016/j.socscimed.2024.117186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/31/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
The expansion of hospice care worldwide has been received differently by medical communities in different societies. Nonetheless, existing efforts to explain how culture affects the reception of hospice care are inadequate. On the basis of fieldwork conducted in Chinese medical institutions and care facilities between 2017 and 2022, this paper draws on a theoretical framework that distinguishes between declarative culture and nondeclarative culture at the personal level to explain the discrepancies between healthcare professionals' beliefs regarding the value of hospice care and their daily healthcare practice. Moreover, this paper uses the concept of cultural scaffolding to demonstrate that the culture of hospice care and the culture of medical institutions are not separate, independent entities but rather evolve together to produce new and local forms of hospice care in the Chinese context. This analysis helps clarify the obstacles and opportunities associated with hospice care in China and contributes to existing research on the reception of hospice care worldwide.
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Affiliation(s)
- Xiao Mei
- School of Social Development and Public Policy, Fudan University, No. 299, Guonian Road, Shanghai, 200433, China
| | - Jiong Tu
- School of Sociology and Anthropology, Sun Yat-sen University, No.135, Xingang Xi Road, Guangzhou, 510275, China.
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2
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McCauley R, Ryan K, McQuillan R, Foley G. Mutual support between patients and family caregivers in palliative care: A qualitative study. Palliat Med 2023; 37:1520-1528. [PMID: 37830745 PMCID: PMC10657498 DOI: 10.1177/02692163231205130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Patients in receipt of palliative care services are often viewed primarily as recipients of support from their family caregiver. There is a dearth of evidence in palliative care on what comprises mutual support between patients and their family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care. DESIGN Qualitative study comprising semi-structured interviews. Data were analysed using grounded theory procedures. SETTING/PARTICIPANTS Fifteen patients with advanced illness (cancer n = 14, neurodegenerative n = 1) and 21 family caregivers recruited from a large regional-based hospice. RESULTS Mutual support between patients and family caregivers comprised two primary modes in which support was provided and received. Mutual support involved both patients and family caregivers providing similar types of support to each other, and which typically manifested as emotional support. However, mutual support also occurred when patients reciprocated by providing emotional support to their family caregivers to compensate for other forms of support which they felt no longer able to provide. Patients supported family caregivers by involving them in decision-making for care and both patient and family caregiver preferences were influenced by obligation to their respective other. Mutual support comprised both disclosure and concealment. Involving family caregivers in patient care decision-making was intended by patients to help family caregivers adjust to a caregiving role. CONCLUSIONS The findings inform the development and delivery of psychosocial interventions for patients and family caregivers in palliative care aimed at facilitating supportive relations between them.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St. Francis Hospice Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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3
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Cain CL. Valuing Black lives and the 'Good Death' in the United States. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1840-1844. [PMID: 34224146 DOI: 10.1111/1467-9566.13310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Cindy L Cain
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, USA
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4
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Suurmond J, Lanting K, de Voogd X, Oueslati R, Boland G, van den Muijsenbergh M. Twelve tips to teach culturally sensitive palliative care. MEDICAL TEACHER 2021; 43:845-850. [PMID: 33070696 DOI: 10.1080/0142159x.2020.1832650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
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Affiliation(s)
- Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Katja Lanting
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Academy of Health (AGZ), Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Xanthe de Voogd
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gudule Boland
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
- Department of Primary Care and Community Health, Radboud University Nijmegen, Nijmegen, The Netherlands
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5
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Preferences for end-of-life care settings among the healthy population in Israel—Related socio-demographic variables. Palliat Support Care 2021; 20:383-388. [DOI: 10.1017/s1478951521000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective
Preferences for end-of-life (EoL) care settings is of considerable interest for developing public health policy and EoL care strategies. Culture, the cause of illness, and background characteristics may impact preferences. The present study aimed to explore preferences for EoL care settings: homes, hospitals, and inpatient hospice units among the general healthy population in Israel. Possible associations between the setting preferences and socio-demographic characteristics were also examined.
Method
A cross-sectional survey was conducted among 311 healthy adults who were recruited through a representative internet panel of the Israeli population using the Israeli census sampling method. The sex ratio was almost 1:1 with 158 women (50.8%) and 153 men (49.2%). All participants completed self-report measures using an online survey system. The questionnaires assessed sociodemographics and preferences for EoL care settings.
Results
This survey revealed that 52.1% of the participants expressed preference for being cared for at home rather than in an inpatient hospice unit, 40.8% expressed being cared for at home rather than in a hospital, while 36.7% had no preference regarding being cared for in hospital or in a hospice unit. Among the socio-demographic variables, only age and gender were found to be significantly associated with preferences for EoL care settings.
Significance of results
The present study highlights the need to be cautious when regarding home as the preferred EoL care setting, as some individuals declared that they would prefer EoL hospice/hospital care. Age and gender should be considered when discussing and tailoring strategies regarding EoL preferences.
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McCauley R, McQuillan R, Ryan K, Foley G. Mutual support between patients and family caregivers in palliative care: A systematic review and narrative synthesis. Palliat Med 2021; 35:875-885. [PMID: 33794713 PMCID: PMC8114453 DOI: 10.1177/0269216321999962] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients in palliative care are usually conceptualised as recipients of support from family caregivers. Family caregivers in palliative care are typically defined as providers of support to patients. Little is known about reciprocal dimensions of support provision between patients and family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care and factors that contribute to or obstruct mutual support between patients and family caregivers in palliative care. DESIGN Systematic review and narrative synthesis of original peer-reviewed research published between January 2000 and March 2020. DATA SOURCES Medline, CINAHL, Embase, AMED, PsycINFO and PsycARTICLES. RESULTS After full-text screening, 10 studies were included. We identified that patients and family caregivers in palliative care can support one another by mutually acknowledging the challenges they face, by remaining positive for one another and by jointly adapting to their changing roles. However, patients and family caregivers may not routinely communicate their distress to each other or reciprocate in distress disclosure. A lack of mutual disclosure pertaining to distress can result in conflict between patients and family caregivers. CONCLUSIONS Few studies have focused in whole or in part, on reciprocal dimensions of support provision between patients with advancing non-curable conditions, and their family caregivers in palliative care. Further research is required to identify key domains of mutual support between patients and family caregivers in palliative care.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland.,Royal College of Surgeons of Ireland, Dublin, Ireland.,Beaumont Hospital Dublin, Dublin, Ireland
| | - Karen Ryan
- University College Dublin, Dublin, Ireland.,Mater Hospital Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Abstract
Health care providers are coping with unprecedented deaths, decisions for which patient receives a lifesaving ventilator, and the personal fear of contracting a virus that presently has no known treatment protocol. This article discusses the concepts of moral injury; compassion fatigue; experiencing secondary stress associated with a continuous demanding daily work environment; and the idea of giving your patient a “good death” during a time when even if family and friends are present during the dying process, there is no touching, kissing, or ability to offer physical comfort. Suggestions for self-care for yourself and colleagues are discussed.
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Daniels-Howell C. Caring for Children With Life-Limiting Illness in Bloemfontein, South Africa: Challenging the Assumptions of the 'Good Death'. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:317-344. [PMID: 32703072 DOI: 10.1177/0030222820944099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Theories of good death focused on acceptance, control, and meaning-making inform adult palliative care in high-resource settings. As children's palliative and hospice care (CPHC) develops in resource-limited settings, critical conceptualisations of a good death for children across these diverse settings are unknown. Assessed against high-resource setting tenets of good death from carer perspectives, results suggest: carer agency is limited; advanced discussion of death does not occur; distress results from multiple burdens; basic survival is prioritised; physical pain is not an emphasised experience; and carers publicly accept death quickly while private grief continues. Hegemonic conceptions of 'good death' for children do not occur in contexts where agency is constrained and discussing death is taboo, limiting open discussion, acceptance, and control of dying experiences. Alternate forms of discourse and good death could still occur. Critical, grounded conceptualisations of good death in individual resource-limited settings should occur in advance of CPHC development to effectively relieve expansive suffering in these contexts.
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Kenny K, Broom A, Kirby E, Oliffe JL, Wyld D, Lwin Z. Reciprocity, Autonomy, and Vulnerability in Men's Experiences of Informal Cancer Care. QUALITATIVE HEALTH RESEARCH 2020; 30:491-503. [PMID: 31216932 DOI: 10.1177/1049732319855962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Men are increasingly participating, and acknowledging their roles, as informal carers. Yet, there has been comparatively little exploration of their experiences therein, especially within the context of cancer care. Here, drawing on semi-structured qualitative interviews with 16 Australian male carers for a relative with cancer, and using constructivist grounded theory, we explore their experiences of informal caring. Our analysis highlights a series of tensions, including the following: the meanings and practicalities of care provision including notions of reciprocity, duty, autonomy, and interdependence; the discomforts of dependency and vulnerability; and the complicated moralities that inflect "caring well." Given the shifting dynamics around informal care, we argue for increased attention to the affective tensions that arise at the nexus of moralities and masculinities in informal caring relations, especially as they are articulated in the context of illness, affliction, and dependency.
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Affiliation(s)
- Katherine Kenny
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Emma Kirby
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - John L Oliffe
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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10
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Krikorian A, Maldonado C, Pastrana T. Patient's Perspectives on the Notion of a Good Death: A Systematic Review of the Literature. J Pain Symptom Manage 2020; 59:152-164. [PMID: 31404643 DOI: 10.1016/j.jpainsymman.2019.07.033] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT There is no clear definition of what constitutes a good death or its features. Patients, caregivers, physicians, and relatives have different notions of a good death. Discussions have been driven by academic perspectives, with little research available on the patients' perspectives. OBJECTIVES To explore the notions of a good death from the patients' perspective. METHODS A systematic literature search was conducted up to November 2017 using CINAHL®, MEDLINE®, EMBASE®, and PsycINFO® databases. Search terms used were "quality of death," "good death," "quality of dying," or "good dying." Scientific empirical studies that included the exploration of the notion of a good death in adult patients with advanced and life-threatening diseases were selected separately by two researchers. Hawker's et al. criteria were used to assess the quality of articles. The analysis was conducted using a thematic analysis. RESULTS Two thousand six hundred and fifty two titles were identified; after elimination of duplicates, screening, and final selection, 29 relevant publications remained for analysis. Sample populations included patients with terminal diseases (AIDS, cardiovascular disease, and cancer). Core elements for a "good death" included control of pain and symptoms, clear decision-making, feeling of closure, being seen and perceived as a person, preparation for death, and being still able to give something to others; whereas other factors such as culture, financial issues, religion, disease, age, and life circumstances were found to shape the concept across groups. Studies agree on the individuality of death and dying while revealing a diverse set of preferences, regarding not only particular attributes but also specific ways in which they contribute to a good death. CONCLUSIONS Although sharing common core elements, patients' notions of good death are individual, unique, and different. They are dynamic in nature, fluctuating within particular groups and during the actual process of dying. Formal and informal caregivers should carefully follow-up and respect the patient's individual concepts and preferences regarding death and dying, while attending to shared core elements, to better adjust clinical decisions.
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Affiliation(s)
- Alicia Krikorian
- Group of Pain and Palliative Care, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.
| | - Camilo Maldonado
- Faculty of Medicine, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany
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11
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Cain CL, McCleskey S. Expanded definitions of the 'good death'? Race, ethnicity and medical aid in dying. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1175-1191. [PMID: 30950077 PMCID: PMC6786270 DOI: 10.1111/1467-9566.12903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The range of end-of-life options is expanding across North America. Specifically, medical aid in dying (AID), or the process by which a patient with a terminal illness may request medical assistance with hastening death, has recently become legal in eight jurisdictions in the United States and all of Canada. Debates about AID often rely on cultural constructions that define some deaths as 'good' and others as 'bad'. While research has found commonalities in how patients, family members and health care providers define good and bad deaths, these constructions likely vary across social groups. Because of this, the extent to which AID is seen as a route to the good death also likely varies across social groups. In this article, we analyse qualitative data from six focus groups (n = 39) across three racial and ethnic groups: African American, Latino and white Californians, just after a medical AID law was passed. We find that definitions of the 'good death' are nuanced within and between groups, suggesting that different groups evaluate medical AID in part through complex ideas about dying. These findings further conversations about racial and ethnic differences in choices about end-of-life options.
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Affiliation(s)
- Cindy L Cain
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sara McCleskey
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
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12
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Green R. Maintaining masculinity: Moral positioning when accounting for prostate cancer illness. Health (London) 2019; 25:399-416. [PMID: 31144532 DOI: 10.1177/1363459319851555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article explores men's experiences following treatment for prostate cancer through the lens of chronic illness. Recent empirical work suggests prostate cancer may be better understood as a chronic illness. Prostate cancer offers a case study to examine how older men's masculinities are disrupted by chronic illness experience. Qualitative interviews with 29 men, recruited from two prostate cancer support groups, explored prostate cancer and post-treatment experiences. Men's experiences are examined by drawing on the works of Steve Robertson and Kathy Charmaz for understanding masculinities in relation to health and illness. Aspects of chronic illness experience are identified in men's accounts, particularly concerns with loss of moral status resulting from ongoing and potentially stigmatising treatment side effects. Four forms of moral positioning are identified that align with Steve Robertson's empirically derived model theorising the relationship between health and hegemonic masculinity. These findings facilitate discussion of the interaction between chronic illness experience, morality and masculinities, providing insight into how older men maintain their masculinity in the wake of illness.
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13
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Plys E, Smith R, Jacobs ML. Masculinity and Military Culture in VA Hospice and Palliative Care: A Narrative Review With Clinical Recommendations. J Palliat Care 2019; 35:120-126. [PMID: 31146630 DOI: 10.1177/0825859719851483] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article examines the intersection between masculinity, military culture, and hospice and palliative care (HPC). The authors conducted a narrative literature review, supplemented with clinical annotations, to identify the impact of masculinity and military culture on the following topics salient to end-of-life care with older male veterans: pain management, mental health, coping, communication, autonomy and respect, and family roles. Findings suggest that traits associated with masculinity and military culture have an influence on the end-of-life process and HPC for older male veterans. Specifically, results suggest that older male veterans may deny or minimize physical pain, decline mental health treatment, utilize maladaptive coping strategies, avoid emotional conversations, struggle to manage perceived shifts in autonomy, and experience challenges negotiating changing family roles. The authors provide clinical recommendations for providers across various disciplines to address the aforementioned concerns with older male veterans in HPC. Overall, information presented in this article may be an important contribution to the literature for building cultural competencies with older male veterans and has the potential to improve the delivery of HPC for veterans and their families.
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Affiliation(s)
- Evan Plys
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA.,Department of Internal Medicine, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Ronald Smith
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA
| | - M Lindsey Jacobs
- Geriatric Mental Health, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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14
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Oliffe JL, Broom A, Kelly MT, Bottorff JL, Creighton GM, Ferlatte O. Men on Losing a Male to Suicide: A Gender Analysis. QUALITATIVE HEALTH RESEARCH 2018; 28:1383-1394. [PMID: 29683063 DOI: 10.1177/1049732318769600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men's overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The "unforeseen suicides" referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, "rationalized suicides" detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause-effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, "managing emotions" whereby participants distanced themselves, but also drew meaning from the suicide.
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Affiliation(s)
- John L Oliffe
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Broom
- 2 University of New South Wales, Sydney, New South Wales, Australia
| | - Mary T Kelly
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Bottorff
- 3 The University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | | | - Olivier Ferlatte
- 1 The University of British Columbia, Vancouver, British Columbia, Canada
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15
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Foley G. The supportive relationship between palliative patients and family caregivers. BMJ Support Palliat Care 2018; 8:184-186. [PMID: 29353254 DOI: 10.1136/bmjspcare-2017-001463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
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16
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Ayers N, Vydelingum V, Arber A. An ethnography of managing emotions when talking about life-threatening illness. Int Nurs Rev 2017; 64:486-493. [DOI: 10.1111/inr.12356] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N.E. Ayers
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - V. Vydelingum
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
| | - A. Arber
- Faculty of Health and Medical Sciences; University of Surrey; Guildford UK
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17
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Ernst J, Mehnert A, Weis J, Faust T, Giesler JM, Roick J. [Social counseling in outpatient cancer counseling centers : Offers and use by advice-seekers]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1476-1483. [PMID: 27695938 DOI: 10.1007/s00103-016-2440-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outpatient psychosocial cancer care has gained importance in recent years and psychosocial counselling services (PCS) offer a broad spectrum of counselling interventions. Yet there is no published research on PCS legal counselling services. This study investigated the range of issues addressed by legal counselling and their relationship with characteristics of advice seekers and counsellors. METHODS We analyzed the records of 21 PCS funded by the German Cancer Aid (DKH) including 5203 advice seekers (80 % patients, 20 % others including friends and family; age ∅ 54 years; 24 % male) in 20,947 counselling sessions. We calculated descriptive statistics and binary logistic regression analyses (legal counselling: yes/no). RESULTS Fifty-five percent of counselling seekers received legal counselling and 28 % approached the PCS exclusively for legal counselling. The proportion of people seeking legal advice ranged from 15 to 87 % between counselling centers. The most common topics during legal counselling were medical rehabilitation programs (57 %) and disability law (43 %). Counselling occurred in a single session in 68 % of cases and was mostly sought by older and unemployed persons with a recent diagnosis. Legal counselling made up 18 % of counselling time. Legal advice was mostly given by social workers (71 %). CONCLUSIONS Legal counselling is a major part of psychosocial care services. Our results reveal large differences between counselling centers. Further research on quality of care and efficacy of legal counseling is needed.
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Affiliation(s)
- Jochen Ernst
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland.
| | - Anja Mehnert
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
| | - Joachim Weis
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Tanja Faust
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Jürgen M Giesler
- Universitätsklinikum Freiburg, Klinik für Tumorbiologie, UKF Reha gGmbh Freiburg/Br., Freiburg, Deutschland
| | - Julia Roick
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
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18
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Abstract
AbstractObjective:The “good death” is a dynamic concept and has evolved over time to become a “revivalist” good death: a planned, peaceful, and dignified death, at home, surrounded by family members. As the “good death” continues to evolve, the key questions are: How do cultural perceptions of death and dying change? What are the forces that shape Western attitudes and beliefs around death and dying? And how does the “good death” discourse frame the dying experience in contemporary society? The purpose of this manuscript is to describe the underlying discourse in the literature on the “good death” in Western societies.Method:An integrative literature review of data from experimental and nonexperimental sources in PubMed, CINAHL, PsychINFO, and SocINDEX of 39 articles from 1992 to 2014.Results:Four main themes emerged from reviewing 39 articles on the “good death”: (1) the “good death” as control, (2) the wrong “good death,” (3) the threatened “good death,” and (4) the denial of dying.Significance of Results:Evolving in response to prominent social attitudes and values, the contemporary “good death” is a powerful, constraining discourse that limits spontaneity and encourages one way to die. Social, political, and demographic changes now threaten the stability of the “good death”; dying is framed as an increasingly negative or even unnecessary process, thus marginalizing the positive aspects of dying and rendering dying absent, invisible.
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Wright DK, Brajtman S, Cragg B, Macdonald ME. Delirium as letting go: An ethnographic analysis of hospice care and family moral experience. Palliat Med 2015; 29:959-66. [PMID: 25855632 DOI: 10.1177/0269216315580742] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Delirium is extremely common in dying patients and appears to be a major threat to the family's moral experience of a good death in end-of-life care. AIM To illustrate one of the ways in which hospice caregivers conceptualize end-of-life delirium and the significance of this conceptualization for the relationships that they form with patients' families in the hospice setting. DESIGN Ethnography. SETTING/PARTICIPANTS Ethnographic fieldwork was conducted at a nine-bed, freestanding residential hospice, located in a suburban community of Eastern Canada. Data collection methods included 15 months of participant observation, 28 semi-structured audio-recorded interviews with hospice caregivers, and document analysis. RESULTS Hospice caregivers draw on a culturally established framework of normal dying to help families come to terms with clinical end-of-life phenomena, including delirium. By offering explanations about delirium as a natural feature of the dying process, hospice caregivers strive to protect for families the integrity of the good death ideal. CONCLUSION Within hospice culture, there is usefulness to deemphasizing delirium as a pathological neuropsychiatric complication, in favor of acknowledging delirious changes as signs of normal dying. This has implications for how we understand the role of nurses and other caregivers with respect to delirium assessment and care, which to date has focused largely on practices of screening and management.
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Hilário AP. Making sense of a changed physical body: why gender matters at end of life. J Aging Stud 2015; 33:58-66. [PMID: 25841730 DOI: 10.1016/j.jaging.2015.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 11/29/2022]
Abstract
The bodily experience of patients near end of life has been presented within sociological literature as largely undifferentiated. The attempt of this paper is to overcome this gap by exploring how gender intersects with the loss of bodily autonomy experienced by hospice patients. The study was conducted in two in-patient hospice units located near Lisbon, the capital of Portugal. A total of ten terminally ill patients were interviewed, along with twenty family members and twenty members of hospice staff. For the men in this study loss of bodily autonomy was a very dramatic experience as it contravened masculine norms. The women's reactions towards their loss of autonomy were less negative compared to those of men and they made a considerable effort to integrate the best as they could their physical condition. This reflected feminine traits. Findings suggested that the loss of bodily autonomy is gendered in the sense that men and women experience it in dissimilar ways.
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Affiliation(s)
- Ana Patrícia Hilário
- Center for Research and Studies in Sociology, University Institute of Lisbon, CIES-IUL, Portugal
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MacArtney JI, Broom A, Kirby E, Good P, Wootton J, Yates PM, Adams J. On resilience and acceptance in the transition to palliative care at the end of life. Health (London) 2014; 19:263-79. [DOI: 10.1177/1363459314545696] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Specialist palliative care is a prominent and expanding site of health service delivery, providing highly specialised care to people at the end of life. Its focus on the delivery of specialised life-enhancing care stands in contrast to biomedicine’s general tendency towards life-prolonging intervention. This philosophical departure from curative or life-prolonging care means that transitioning patients can be problematic, with recent work suggesting a wide range of potential emotional, communication and relational difficulties for patients, families and health professionals. Yet, we know little about terminally ill patients’ lived experiences of this complex transition. Here, through interviews with 40 inpatients in the last few weeks of life, we explore their embodied and relational experiences of the transition to inpatient care, including their accounts of an ethic of resilience in pre-palliative care and an ethic of acceptance as they move towards specialist palliative care. Exploring the relationship between resilience and acceptance reveals the opportunities, as well as the limitations, embedded in the normative constructs that inflect individual experience of this transition. This highlights a contradictory dynamic whereby participants’ experiences were characterised by talk of initiating change, while also acquiescing to the terminal progression of their illness.
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Affiliation(s)
| | | | | | - Phillip Good
- St Vincent’s Private Hospital Brisbane, Australia
| | | | | | - Jon Adams
- University of Technology, Sydney, Australia
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Meanings and experiential outcomes of bodily care in a specialist palliative context. Palliat Support Care 2014; 13:625-33. [PMID: 24762673 DOI: 10.1017/s147895151400025x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study was to enhance the depth of existing knowledge about meanings and experiential outcomes of bodily care in the context of an inpatient specialist palliative setting. METHOD Interpretative phenomenology was chosen as the study sought to explore individuals' lived experiences related to bodily care. Nine participants (five women, four men) of various ages and with various metastasized cancers and bodily-care needs, all from one specialist palliative care ward, participated. Data were collected with repeated narrative interviews and supplementary participating observations. Analysis was informed by van Manen's approach. RESULTS The following meanings and experiential outcomes of bodily care were revealed by our study: maintaining and losing body capability, breaching borders of bodily integrity, being comforted and relieved in bodily-care situations, and being left in distress with unmet needs. These meanings overlap and shape the nature of each other and involve comforting and distressing experiences related to what can be described as conditional dimensions: the particular situation, one's own experiences of the body, and healthcare professionals' approaches. SIGNIFICANCE OF RESULTS The results, based on specialist palliative care patients' experiences, outline the meanings and outcomes that relate to the quintessence and complexity of palliative care, deriving from dying persons' blend of both basic and symptom-oriented bodily-care needs. Moreover, the results outline how these two dimensions of care equally influence whether comfort and well-being are facilitated or not. Considering this, specialist palliative care may consider how to best integrate and acknowledge the value of skilled basic nursing care as part of and complementary to expertise in symptom relief during the trajectories of illness and dying.
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Broom A, Kirby E, Good P, Wootton J, Adams J. The troubles of telling: managing communication about the end of life. QUALITATIVE HEALTH RESEARCH 2014; 24:151-162. [PMID: 24469692 DOI: 10.1177/1049732313519709] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Communication about palliative care represents one of the most difficult interpersonal aspects of medicine. Delivering the "terminal" diagnosis has traditionally been the focus of research, yet transitions to specialist palliative care are equally critical clinical moments. Here we focus on 20 medical specialists' strategies for engaging patients around referral to specialist palliative care. Our aim was to develop an understanding of the logics that underpin their communication strategies when negotiating this transition. We draw on qualitative interviews to explore their accounts of deciding whether and when to engage in referral discussions; the role of uncertainty and the need for hope in shaping communication; and their perceptions of how patient biographies might shape their approaches to, and communication about, the end of life. On the basis of our analysis, we argue that communication is embedded in social relations of hope, justice, and uncertainty, as well as being shaped by patient biographies.
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Affiliation(s)
- Alex Broom
- 1The University of Queensland, Brisbane, Queensland, Australia
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Broom A, Kirby E. The end of life and the family: hospice patients' views on dying as relational. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:499-513. [PMID: 22742736 DOI: 10.1111/j.1467-9566.2012.01497.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The end of life is a highly emotive and critical period in the life course and families often play a central role during this time. Despite significant sociological work on dying as a relational experience, there has been little exploration of the significance of contemporary family structures and relations. In this article, drawing on the accounts of twenty hospice in-patients, we explore how the end of life (in this case within an in-patient unit) is mediated by family dynamics and expectations. Participants' accounts reveal a range of interpersonal experiences, including: pressures and strains on families and patients; differentiation in family responses to and involvement in the dying process; and tensions between individual and family preferences/desires. We argue that family dynamics strongly influence individual experiences near death and that the focus on individual preferences and the management of disease in palliative care contexts must be augmented with sophisticated and nuanced understandings of the family context. We suggest that sociological conceptual explanations of shifts in social and family life, such as individualisation and ontological security, may also help us better understand the ways families approach and respond to the dying process.
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Affiliation(s)
- Alex Broom
- School of Social Science, University of Queensland, Brisbane, Australia.
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'The calendar is just about up': older adults with multiple chronic conditions reflect on death and dying. AGEING & SOCIETY 2012; 32:1399-1417. [PMID: 24976657 DOI: 10.1017/s0144686x11001061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Drawing on data from in-depth interviews with 35 men and women aged 73-91, this article examines the ways in which older adults with multiple chronic conditions talk about and prepare for death and dying. While the focus of the original study did not include questions concerning the end-of-life, the majority of our participants made unprompted remarks regarding their own and others' mortality. The participants discussed the prevalence of death in their lives as it related to the passing of significant others, as well as their own eventual demise. Additionally, the men and women expressed hopes and fears about their impending death, in particular with respect to prolonged pain and suffering, institutionalisation, and a loss of mental acuity and independence. Many of our participants also described their end-of-life plans, which included making funeral arrangements, obtaining living wills, and planning their suicides. They further reported a number of barriers to their planning for death, including a lack of willingness on the part of family members to discuss their wishes as well as a scarcity of institutional resources and support. We discuss our findings in relation to the extant research concerning older adults' experiences of death and dying, as well as Glaser and Strauss' (1971) theory of status passage and Marshall's (1986) conceptualisation of authorship and the legitimation of death.
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Breheny M, Stephens C. Negotiating a moral identity in the context of later life care. J Aging Stud 2012; 26:438-47. [PMID: 22939540 DOI: 10.1016/j.jaging.2012.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 05/17/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
Strategies to maintain independence for older people have received considerable attention as a social policy solution to the financial and social impact of the ageing population. Critical scholars in gerontology have also highlighted the negative consequences of promoting independence in this way. Understandings of independence have profound implications for caring relationships as people age. To investigate the ways that older people talk about caring we interviewed 48 people aged 55-70 years. A discourse analysis of these data showed that a dominant discourse of 'independence' was drawn upon to value self-sufficiency and construct dependence on others as burdensome. This construction of care provides a comfortable position for those who can afford to purchase professional care; however, those without resources are unable to accept unpaid help without also accepting a position of dependency. An alternative discourse of 'being there' constructs having others to provide personal care as a virtue and obligations to provide such care as based on family duty and affection. This discourse emphasises connections between people and a moral obligation to care which also creates difficulties for those with fewer material resources. The position for a dependent older subject in these two discourses may seem incompatible but can be reconciled by reframing independence as autonomy. Autonomy for those requiring care alongside a wider recognition of caring as the responsibility of all members of the community rather than with individual family members would support a flexible approach to later life care arrangements.
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Affiliation(s)
- Mary Breheny
- School of Health and Social Services, Massey University, New Zealand.
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Broom A. On euthanasia, resistance, and redemption: the moralities and politics of a hospice. QUALITATIVE HEALTH RESEARCH 2012; 22:226-237. [PMID: 21908705 DOI: 10.1177/1049732311421181] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Euthanasia/assisted dying, the desire to hasten death, and religious supportive care at the end of life are controversial issues that have been heavily debated within the academic and medical communities. Little research has been done on hospice patients' views, despite hospices being political spaces, espousing a range of perspectives on assisted dying, religiosity, and "good deaths." In this article I document the presence, articulation, and significance of these issues as perceived and experienced by 20 hospice inpatients in the last 4 weeks of their lives. Key themes to emerge included polarization in desire for hastened death and assisted dying in the hospice; the hospice as a morally bound space situated within particular notions of "dying well"; and the divisive character of religion as part of formalized hospice care. Theoretically, the participants' perspectives on euthanasia/assisted dying and religiosity in the hospice provide a means of unpacking and revealing the moral economy of modern dying practices and the institutional governance and production of "timely deaths."
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Affiliation(s)
- Alex Broom
- School of Social Science, The University of Queensland, Brisbane, Australia.
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Carlander I, Ternestedt BM, Sahlberg-Blom E, Hellström I, Sandberg J. Four aspects of self-image close to death at home. Int J Qual Stud Health Well-being 2011; 6:10.3402/qhw.v6i2.5931. [PMID: 21526139 PMCID: PMC3082294 DOI: 10.3402/qhw.v6i2.5931] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2011] [Indexed: 11/23/2022] Open
Abstract
Living close to death means an inevitable confrontation with one's own existential limitation. In this article, we argue that everyday life close to death embodies an identity work in progress. We used a narrative approach and a holistic-content reading to analyze 12 interviews conducted with three persons close to death. By illuminating the unique stories and identifying patterns among the participants' narratives, we found four themes exemplifying important aspects of the identity work related to everyday life close to death. Two of the themes, named "Inside and outside of me" and "Searching for togetherness," represented the core of the self-image and were framed by the other themes, "My place in space" and "My death and my time." Our findings elucidate the way the individual stories moved between the past, the present, and the future. This study challenges the idea that everyday life close to impending death primarily means limitations. The findings show that the search for meaning, new knowledge, and community can form a part of a conscious and ongoing identity work close to death.
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Affiliation(s)
- Ida Carlander
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden
| | - Britt-Marie Ternestedt
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden
- Research and Development Unit, Stockholm Sjukhem Foundation, Stockholm, Sweden
| | - Eva Sahlberg-Blom
- School of Health and Medical Sciences Örebro University, Örebro, Sweden
| | - Ingrid Hellström
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Jonas Sandberg
- Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden
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