We’re delighted to present this month’s ‘Editor’s Choice’ from Palliative Medicine, the official research journal of the EAPC. You can read the longer article in Palliative Medicine which EAPC members can access free from the EAPC website. Sofia Morberg Jämterud and Anna Sandgren asks what influences the timing and identification of patients for serious illness conversations?
Serious illness conversations give patients and their family members an opportunity to talk with their clinicians about wishes and priorities about their care.From previous research we know that this can decrease patients’ anxiety and increase their chances of receiving care that is in accordance with their wishes.1 But it can be difficult to identify which patients should be offered these conversations
In our recent article in Palliative Medicine we examine the question of identification, and more specifically, we explore healthcare professionals’ perceptions about factors influencing the identification process of patients for serious illness conversations. During the implementation of the Serious Illness Care Program2 at two hospitals in Sweden, we observed team meetings where identification was discussed, and we conducted semi-structured interviews with physicians and nurses. The data was collected at a broad range of clinics and did not include specialised palliative care units.
So what did we find? Identification of patients for serious illness conversations is a process influenced by a multitude of factors, such as the patients’ palliative care needs, continuity in patient–professional relations and continuity of staff. Identifying the ‘right’ patient (for example a patient with palliative care needs) and doing so at the ‘right time’ (for example, not too early nor too late in the illness trajectory) were seen as key aspects. Healthcare professionals also pointed out that serious illness conversations can be very emotional and challenging for both parties. Therefore, it is important to have established relationships and continuity in relations between a healthcare team and a patient as a starting point for identification. As one clinician stated: ‘But then, I’m also thinking that it’s important not to barge in. These kinds of conversations somehow require a relation.’
Serious illness conversations may often include the topic of death and dying, and this was considered to have a negative impact on the patient’s hope and since hope is of significance for survival, this becomes a real ethical obstacle. Thus, identification can involve existential and ethical concerns which may impact healthcare professionals’ willingness to identify patients and offer serious illness conversations. However, research has shown that if clinicians are trained to have these conversations, these conversations do not decrease the patients’ hope.3 But even so, the hesitation remains and it is important to take it seriously. Here it becomes clear that these conversations not only require skills in conversation methodology but that they also they touch upon profound human values. Palliative care is based on values such as a holistic view of the human being where care for existential concerns is integral to the meaning of ‘good care’. Furthermore, addressing these existential needs is considered to be an area of responsibility of care – as pointed to in an EAPC White Paper on multi-disciplinary education for spiritual care in palliative care.4 We suggest that it is crucial to address ethical and existential obstacles that can hinder healthcare professionals feeling able and confident to have these conversations. This may be particularly important in non-specialist palliative care contexts. We recognise that identifying patients for serious illness conversations can be challenging but doing so can improve care and experiences for individuals and their families and makes sure that care is in line with their wishes.
READ THE FULL ARTICLE IN ‘PALLIATIVE MEDICINE’
We hope you’ll read the longer article in ‘Palliative Medicine’ – EAPC members can access a FREE copy from the EAPC website. ‘Health care professionals’ perceptions of factors influencing the process of identifying patients for serious illness conversations: A qualitative study.’ Sofia Morberg Jämterud and Anna Sandgren. First Published: Palliative Medicine, Volume: 36 issue: 7, page(s): 1072-1079.
- Bernacki R, Paladino J, Neville BA, et al. Effect of the serious illness care program in outpatient oncology: a cluster randomized clinical trial. JAMA Intern Med 2019; 179(6): 751–759.
- Bernacki R, Hutchings M, Vick J, et al. Development of the serious illness care program: a randomised controlled trial of a palliative care communication intervention. BMJ Open 2015; 5(10): e009032.
- Thamcharoen N, Nissaisorakarn P, Cohen RA, et al. Serious illness conversations in advanced kidney disease: a mixed-methods implementation study. BMJ Support Palliat Care. Epub ahead of print 17 March 2021. DOI: 10.1136/bmjsp-care-2020-002830.
- Best M, Leget C, Goodhead A, et al. An EAPC white paper on multi-disciplinary education for spiritual care in palliative care. BMC Palliat Care 2020; 19(1): 1–10.
Links and resources
Read earlier Palliative Medicine Editor’s Choice posts on the EAPC blog.
Follow Palliative Medicine on Twitter @palliativemedj
About the authors
Sofia Morberg Jämterud, PhD, is a postdoctoral researcher at Linköping University, and she was recently at Center for Collaborative Palliative Care at Linnaeus University, Sweden. She specialises in medical ethics and has written on issues such as dignity in the end of life and on the relation between vulnerability and autonomy in ethics of palliative care. Twitter: @MorbergSofia. ORCID no: 0000-0003-2998-3971.
Anna Sandgren, RN, PhD, is an Associate Professor at Linnaeus University and serves as the Director for the Center for Collaborative Palliative Care, Sweden. Twitter: @AnnaSandgren70. ORCID no: 0000-0002-3155-575X.
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