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Tytuł:
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Affording opportunities to discuss deterioration in paediatric palliative care consultations: a conversation analytic study.
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Autorzy:
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Ekberg S; Institute of Health and Biomedical Innovation and School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia.
Danby S; School of Early Childhood, Queensland University of Technology, Brisbane, Queensland, Australia.
Herbert A; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.
Bradford NK; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.
Yates P; Institute of Health and Biomedical Innovation and School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
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Źródło:
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BMJ supportive & palliative care [BMJ Support Palliat Care] 2020 Jun; Vol. 10 (2), pp. e13. Date of Electronic Publication: 2017 Mar 07.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: London : BMJ Publishing Group
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MeSH Terms:
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Advance Care Planning*
Professional-Family Relations*
Referral and Consultation*
Palliative Care/*psychology
Pediatrics/*methods
Adult ; Australia ; Child ; Child, Preschool ; Communication ; Family/psychology ; Female ; Humans ; Palliative Care/methods
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Contributed Indexing:
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Keywords: Communication; Family management; Paediatrics; Prognosis
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Entry Date(s):
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Date Created: 20170309 Date Completed: 20201013 Latest Revision: 20201013
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Update Code:
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20240105
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DOI:
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10.1136/bmjspcare-2016-001130
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PMID:
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28270396
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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: 9 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.
Competing Interests: Competing interests: AH was a participant in the study.
(Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)
