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Alvarez MF. In search of a tranquil "silence of the leaving": Reflections on the Dying To Know Film Festival's (D2KFF) opening weekend. Qual Res Med Healthc 2023; 7:11850. [PMID: 37822325 PMCID: PMC10563026 DOI: 10.4081/qrmh.2023.11850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
As a communication scholar and educator with a background in thanatology (death studies) and film, my curiosity was piqued when, several months ago, a friend and colleague brought to my attention an upcoming film festival on death and dying. Films have the power to provoke visceral contemplation on matters of body and mind that we would prefer to avoid or sanitize. Of such matters, the termination of our cellular activities and cessation of our consciousness and self rank among the highest. If films can make us reflect and introspect, it stands to reason that film festivals, by their communal nature, can turn hushed whispers about life’s finitude into audible dialogue, and I was curious to see how that would unfold.. [...]
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Affiliation(s)
- Mike F. Alvarez
- Department of Communication, University of New Hampshire, Durham, NH, USA
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Diendorfer T, Roider-Schur S, Lütgendorf-Caucig C, Masel EK, Watzke H, Pötter R, Kirchheiner K. 'It needs experience and courage': Awareness towards end of life communication practices in oncologists: A mixed methods study. Eur J Cancer Care (Engl) 2022; 31:e13737. [PMID: 36254927 DOI: 10.1111/ecc.13737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE End of life communication (EOLC) is generally regarded as a challenging aspect of the medical profession, with high influences of culture, the physician's experience and awareness. The aim of the current study was to assess the awareness of Austrian oncologists towards EOLC practices in their daily clinical routine and to identify limiting and supporting factors of these conversations. METHODS Overall, 45 oncologists participated in the assessment in this cross-sectional, mixed-method design using semi-structured interviews and questionnaire. RESULTS Themes that occurred during the interviews included the initiation of EOLC, EOLC in practice, strategies for EOLC, limiting and supporting factors and consequences of EOLC. There were several variations in the EOLC approach, that is, the use of time frames, timing, initiation and the amount of details given to the patient. CONCLUSION Oncologists agreed that EOLC is important in their daily clinical routine and for their patients. Nevertheless, there seems to be an underlying variation in approaches chosen by Austrian oncologists. This variation might be reduced by asking patients about their information preferences in advance and by routine implementation of communication guidelines, nomograms and prognostic calculators to reduce uncertainty.
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Affiliation(s)
- Tamara Diendorfer
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Sophie Roider-Schur
- Clinical Division of Oncology, Department of Internal Medicine I, Sankt Josef Hospital Vienna, Vienna, Austria
| | | | - Eva Katharina Masel
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Watzke
- Clinical Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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Haughey C. More care, less pathway. . .More plans? J R Coll Physicians Edinb 2022; 52:275-276. [PMID: 36207804 DOI: 10.1177/14782715221131640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Treatment Escalation Plans (TEPs) risk becoming the next 'tick box exercise', if not supported by open and compassionate conversations by healthcare teams brave enough to adequately address the culturally taboo subject of death. This requires a wider system of ongoing support, education and clinical leadership to create a culture of open communication. While excellent to read the emphasis that palliative treatments should not be reserved for the terminally ill, further advancements would see 'Supportive Care' move from the lowest levels of escalation to becoming embedded as standard practice for all deteriorating patients. This supportive element of care, underpinned by clear communication, could accompany patients regardless of their level of escalation. Through adopting the Palliative and Supportive Care ethos, addressing not only physical symptom needs, but also exploring social, psychological and spiritual concerns, be it in the ICU or on a general ward, we may move closer towards offering the truly individualised plans of care that TEPs promise.
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Sussman T, Lawrence J, Pimienta R. "This is how I want it": Exploring the use of a workbook with persons with dementia to support advance care planning engagement. Dementia (London) 2022; 21:2601-2618. [PMID: 36151606 PMCID: PMC9583280 DOI: 10.1177/14713012221127358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed method sequential study reports focus group and pilot intervention
findings that (1) explore the views of persons with dementia and their
caregivers on using a self-directed advance care planning engagement workbook
(Your Conversation Starter Kit) and (2) uncover the
conditions that encouraged and hindered workbook use. In Phase 1, we conducted
five focus groups consisting of 10 persons with dementia and eight family
members/caregivers from two urban Canadian cities to explore overall impressions
of the workbook and factors that might affect its use. In Phase 2, we
empirically explored the factors identified in Phase 1 by distributing the
workbook to 24 persons with dementia. The combined findings suggest that the
workbook offers promise in supporting advance care planning engagement for
persons with dementia in the early stages of their condition. Involving
family/caregivers and clarifying some of the ranked questions might improve the
workbook’s use. Persons with dementia without familial support or those who have
never contemplated advance care planning may require additional guidance prior
to workbook distribution.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Canada
| | - Jack Lawrence
- School of Social Work, 5620McGill University, Montreal, Canada
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Abstract
Objective: We aimed to clarify the content of different types of regrets or lack of regret, and the frequency of feeling regret among family caregivers who assisted their relatives during their end of life stage.Method: Seventy primary informal caregivers in Israel were interviewed (17 spouses, 52 children, and 1 cousin) concerning their regret about the end of life of their deceased relative, including a general question about regret and questions about regret concerning life-sustaining treatments. After calculating the frequency of regrets and lack of regret, we conducted a qualitative analysis, using a thematic approach to identify themes and interpret data.Results: A majority of caregivers (63%) expressed regret and about 20% expressed ambivalence involving both regret and denial of regret. Regrets pertained to care given, suffering experienced, and the caregiver's behavior towards, and relationship with the deceased, including missing opportunities to express love and caring toward relatives. Caregivers viewed almost 30% of 75 administered life-sustaining procedures as misguided. Most regrets involved inaction, such as not communicating sufficiently, or not fighting for better care.Conclusion: This article provides a comprehensive description of EoL regrets, and helps clarify the complexity of regrets, lack of regrets, and ambivalence concerning regrets, though the study is limited to one country. Analysis suggests the need for public education concerning the EoL process, and for changes within the health care system to improve communication, to improve understanding of the needs of the terminally ill, and to provide more instruction to family caregivers to help them understand EoL.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel.,The Herczeg Institute on Aging, Tel-Aviv University, Tel Aviv, Israel.,Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shai Brill
- Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, Tel Aviv, Israel.,Beit-Rivka Medical Center, Petah Tikva, Israel
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Willmott L, White B, Ko D, Downar J, Deliens L. Restricting conversations about voluntary assisted dying: implications for clinical practice. BMJ Support Palliat Care 2019; 10:105-110. [PMID: 31391175 DOI: 10.1136/bmjspcare-2019-001887] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES On 19 June 2019, assisted dying became lawful in Victoria, the second most populous state in Australia. Section 8 of the Voluntary Assisted Dying Act is a legislative safeguard that is designed to ensure a patient's request for assistance to die is voluntary. This section prohibits health practitioners from initiating a conversation about assisted dying with the patient. This article explores the potential implications of this prohibition for effective communication between doctors and their patients, and the ability of doctors to provide high quality end-of-life (EOL) care in some cases. METHOD The authors reviewed and analysed literature on the importance of communication at the EOL including the need to understand and appropriately respond to Desire to Die or Desire to Hasten Death statements. A legal critique of section 8 of the Victorian Voluntary Assisted Dying Act was also undertaken to determine the scope of this new duty and how it aligns with existing legal obligations that would otherwise require doctors to provide information about EOL options requested by a patient. RESULTS Contemporary literature suggests that open and honest communication between doctor and patient including the provision of information about all EOL options when sought by the patient represents good clinical practice and will lead to optimal EOL care. The provision of such information also reflects professional, ethical and legal norms. CONCLUSION Despite (arguably) promoting an appropriate policy objective, the legislative prohibition on health professionals initiating conversations about voluntary assisted dying may, in cases where patients seek information about all EOL options, lead to less optimal patient outcomes.
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Affiliation(s)
- Lindy Willmott
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ben White
- Australian Centre for Health Law Research, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danielle Ko
- Austin Health, Heidelberg, Victoria, Australia
| | - James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Deliens
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Tenzek KE, Depner R. Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective. Behav Sci (Basel) 2017; 7:E25. [PMID: 28441339 DOI: 10.3390/bs7020025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
The concept of a good death continues to receive attention in end-of-life (EOL) scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member's perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (dis)continuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed.
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Omilion-Hodges LM, Swords NM. Communication Matters: Exploring the Intersection of Family and Practitioner End of Life Communication. Behav Sci (Basel) 2017; 7:bs7010015. [PMID: 28335501 PMCID: PMC5371759 DOI: 10.3390/bs7010015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022] Open
Abstract
After establishing a baseline understanding of some of the factors that influence and shape family end of life communication, empirical research centered on the communication tendencies of nationally-recognized palliative care clinicians is presented. Because death is no longer confined to the bedroom and individuals are increasingly turning to hospitals and health care institutes to assist with end of life, the role of palliative care practitioners is vital. To that end, common communication-rooted issues that may transpire among various medical personnel are explored. Focus on a shared underlying tension-care vs. cure-links the findings between family and palliative care clinician communication regarding end of life. Practical communication solutions and suggestions are offered to facilitate productive and mindful end of life communication between and among family members and health care practitioners.
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Affiliation(s)
- Leah M Omilion-Hodges
- School of Communication, Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI 49007-5318, USA.
| | - Nathan M Swords
- School of Communication, Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI 49007-5318, USA.
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