15 February 2017
Talking about dying: how palliative medicine doctors give patients and their companions opportunities to discuss end of life
Presented By Marco Pino, Loughborough University
- 1-2 pm (part of the CRCC seminar series)
- Brockington U1.22
About this event
Part of the recent debate around dying has centred on patients’ rights to discuss preferences for end of life care and make advance decisions (preferred place of death and orders to withhold cardiopulmonary resuscitation being two notable examples). This has led to the recommendation that health professionals give patients opportunities to discuss feelings and thoughts about dying as part of the broader agenda of enabling people to prepare for a dignified death. This is not entirely uncontroversial as some argue that, by going down this road, medicine is extending its influence to a domain (discussing thoughts and feelings about dying) that has previously been confined to more private or elective relationships. If we translate this debate into the everyday business of managing clinical work, we can start appreciating how health professionals are regularly faced with a dilemma. They are accountable for initiating EoL discussions with their patients, but they have to do so in ways that are sensitive to each patient’s willingness, readiness, and ability to engage in this type of conversation.
The study presented here took a conversation analytic approach to how doctors go about the practical business of engaging patients and their companions in talk about dying. This is based on 14 conversations between palliative medicine consultants, terminally ill patients, and their companions, which we audio-visually recorded in an English hospice. By illustrating different communication practices that the doctors use to promote EoL talk, we will show how they manage an inherent tension: promoting the topic of dying while avoiding being seen as pushing the patients to engage in this type of conversation. The doctors’ solution to this problem is to systematically create conversational slots where the patients can volunteer talk about dying, rather than overtly solicit it.
The study (led by Ruth Parry) was the result of a collaboration between the University of Nottingham and the LOROS hospice.
Marco Pino studies provider-user communication in health and social care settings using the methodological approach of conversation analysis. He holds a Marie Curie Research Fellowship at the Department of Social Sciences at Loughborough University.
This event is part of the CRCC Seminar Series.