Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T04:38:54.390Z Has data issue: false hasContentIssue false
  • English
  • Français

The positioning of palliative care in acute care: A multiperspective qualitative study in the context of metastatic melanoma

Published online by Cambridge University Press:  12 October 2015

Jennifer Fox Open the ORCID record for Jennifer Fox [Opens in a new window] ,
Carol Windsor Open the ORCID record for Carol Windsor [Opens in a new window] ,
Shirley Connell Open the ORCID record for Shirley Connell [Opens in a new window]  and
Patsy Yates
Jennifer Fox*
Affiliation:
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
Carol Windsor
Affiliation:
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
Shirley Connell
Affiliation:
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
Patsy Yates
Affiliation:
School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
*
Address correspondence and reprint requests to: Jennifer Fox, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Queensland, Australia. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The positioning and meaning of palliative care within the healthcare system lacks clarity which adds a level of complexity to the process of transition to palliative care. This study explores the transition to the palliative care process in the acute care context of metastatic melanoma.

Method:

A theoretical framework drawing on interpretive and critical traditions informs this research. The pragmatism of symbolic interactionism and the critical theory of Habermas brought a broad orientation to the research. Integration of the theoretical framework and grounded-theory methods facilitated data generation and analysis of 29 interviews with patients, family carers, and healthcare professionals.

Results:

The key analytical findings depict a scope of palliative care that was uncertain for users of the system and for those working within the system. Becoming “palliative” is not a defined event; nor is there unanimity around referral to a palliative care service. As such, ambiguity and tension contribute to the difficulties involved in negotiating the transition to palliative care.

Significance of Results:

Our findings point to uncertainty around the scopes of practice in the transition to palliative care. The challenge in the transition process lies in achieving greater coherency of care within an increasingly specialized healthcare system. The findings may not only inform those within a metastatic melanoma context but may contribute more broadly to palliative practices within the acute care setting.

Keywords

PalliativeAcuteSpecializationMelanomaTransition
Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 3 , June 2016 , pp. 259 - 268
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Alvesson, M. & Sköldberg, K. (2009). Reflexive methodology: New vistas for qualitative research. London: Sage Publications.Google Scholar
Arber, A. (2007). “Pain talk” in hospice and palliative care team meetings: An ethnography. International Journal of Nursing Studies, 44, 916–926.CrossRefGoogle ScholarPubMed
Australian Cancer Network Melanoma Guidelines Revision Working Party (2008). Clinical practice guidelines for the management of melanoma in Australia and New Zealand. Sydney: Cancer Council Australia and Australian Cancer Network. Available from http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp111.pdf.Google Scholar
Australian Government (2014). Causes of death, Australia, 2012. Canberra: Australian Bureau of Statistics. Available from http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3303.02012?OpenDocument.Google Scholar
Australian Institute of Health and Welfare (AIHW) (2010). Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: Australian Institute of Health and Welfare. Available from http://www.aihw.gov.au/publication-detail/?id=10737421461.Google Scholar
Australian Institute of Health and Welfare (AIHW) (2012). Australia's health 2012. Australia's Health no 13. Cat no. AUS 156. Canberra: Australian Institute of Health and Welfare. Available from http://www.aihw.gov.au/publication-detail/?id=10737422172.Google Scholar
Bakitas, M., Byock, I.R., Ahles, T.A., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. The Journal of the American Medical Association, 302, 741–749.CrossRefGoogle Scholar
Barry, C.A., Stevenson, F.A., Britten, N., et al. (2001). Giving voice to the lifeworld: More humane, more effective medical care? A qualitative study of doctor–patient communication in general practice. Social Science & Medicine, 53, 487–505.CrossRefGoogle Scholar
Baszanger, I. (2012). One more chemo or one too many? Defining the limits of treatment and innovation in medical oncology. Social Science & Medicine, 75, 864–872.CrossRefGoogle ScholarPubMed
Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Breitbart, W. (2006). The goals of palliative care: Beyond symptom control. Palliative & Supportive Care, 4, 1–2.CrossRefGoogle ScholarPubMed
Broom, A., Kirby, E., Good, P., et al. (2012). Specialists' experiences and perspectives on the timing of referral to palliative care: A qualitative study. Journal of Palliative Medicine, 15, 1248–1253.CrossRefGoogle ScholarPubMed
Campbell, K.H., Sachs, G.A., Hemmerich, J.A., et al. (2010). Physician referral decisions for older chronic kidney disease patients: A pilot study of geriatricians, internists and nephrologists. Journal of the American Geriatrics Society, 58, 392–395.CrossRefGoogle ScholarPubMed
Casali, P.G. (2011). Medical oncology: The long-awaited prize of recognition. Annals of Oncology, 22(8), 1695–1697.CrossRefGoogle ScholarPubMed
Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage Publications.Google Scholar
Charmaz, K. (2009). Shifting the grounds: Constructivist grounded theory methods. In Developing grounded theory: The second generation. Morse, J.M. et al. (eds.), pp. 127–193. Walnut Creek, CA: Left Coast Press.Google Scholar
Charmaz, K. (2011 a). A constructivist grounded theory analysis of losing and regaining a valued self. In Five ways of doing qualitative analysis: Phenomenological psychology, grounded theory, discourse analysis, narrative research, and intuitive inquiry. Wertz, F.J. et al. (eds.), pp. 165–204. New York: Guilford Press.Google Scholar
Charmaz, K. (2011 b). Grounded theory methods in social justice research. In The Sage handbook of qualitative research, 4th ed. Denzin, N.K. & Lincoln, Y.S. (eds.), pp. 359–380. Thousand Oaks, CA: Sage Publications.Google Scholar
Clark, D. (2007). From margins to centre: A review of the history of palliative care in cancer. The Lancet. Oncology, 8, 430–438.CrossRefGoogle ScholarPubMed
Ferrell, B. & Grant, M. (2014). The future of palliative care. Seminars in Oncology Nursing, 30, 296–297.CrossRefGoogle ScholarPubMed
Glaser, B.G. (1978). Theoretical sensitivity. San Francisco: University of California Press.Google Scholar
Glaser, B.G. & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Sociology Press.Google Scholar
Habermas, J. (1984). The theory of communicative action, Volume 1: Reason and the rationalization of society. McCarthy, T. (trans.). Boston: Beacon Press.Google Scholar
Habermas, J. (1987). The theory of communicative action, Volume 2: Lifeworld and system: A critique of functionalist reason. McCarthy, T. (trans.). Boston: Beacon Press.Google Scholar
Hannon, B. & Zimmermann, C. (2013). Early palliative care: Moving from “why” to “how.” Oncology, 27(1), 36. Available from http://www.karger.com/Journal/Home/223857.Google Scholar
Hardy, J., Maresco-Pennisi, D., Gilshenan, K., et al. (2008). Barriers to the best care of the dying in Queensland, Australia. Journal of Palliative Medicine, 11, 1325–1329.CrossRefGoogle Scholar
Hibbert, D., Hanratty, B., May, C., et al. (2003). Negotiating palliative care expertise in the medical world. Social Science & Medicine, 57, 277–288.CrossRefGoogle ScholarPubMed
Higginson, I.J. & Evans, C.J. (2010). What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer Journal, 16, 423–435.CrossRefGoogle ScholarPubMed
Hodi, F.S., O'Day, S.J., McDermott, D.F., et al. (2010). Improved survival with ipilimumab in patients with metastatic melanoma. The New England Journal of Medicine, 363, 711–723.CrossRefGoogle ScholarPubMed
Holleb, A.I. (1972). The cancer patient—Too often alone. CA: A Cancer Journal for Clinicians, 22, 129.Google Scholar
Horowitz, R., Gramling, R. & Quill, T.E. (2014). Palliative care education in U.S. medical schools. Medical Education, 48, 59–66.CrossRefGoogle ScholarPubMed
Howie, L. & Peppercorn, J.M. (2013). Early palliative care in cancer treatment: Rationale, evidence and clinical implications. Therapeutic Advances in Medical Oncology, 5(6), 318–323.CrossRefGoogle ScholarPubMed
Hui, D., Elsayem, A., de la Cruz, M., et al. (2010). Availability and integration of palliative care at U.S. cancer centers. The Journal of the American Medical Association, 303, 1054–1061.CrossRefGoogle ScholarPubMed
Johnson, C.E., Girgis, A., Paul, C.L., et al. (2008). Cancer specialists' palliative care referral practices and perceptions: Results of a national survey. Palliative Medicine, 22, 51–57.CrossRefGoogle ScholarPubMed
Johnson, C., Girgis, A., Paul, C., et al. (2011 a). Australian palliative care providers' perceptions and experiences of the barriers and facilitators to palliative care provision. Supportive Care in Cancer, 19, 343–351.CrossRefGoogle ScholarPubMed
Johnson, C., Paul, C., Girgis, A., et al. (2011 b). Australian general practitioners' and oncology specialists' perceptions of barriers and facilitators of access to specialist palliative care services. Journal of Palliative Medicine, 14, 429–435.CrossRefGoogle ScholarPubMed
Karnofsky, D. (1960). Why prolong the life of a patient with advanced cancer? CA: A Cancer Journal for Clinicians, 10, 9–11.Google ScholarPubMed
Karnofsky, D. (1962). Rationale for aggressive or extraordinary means of treatment of advanced cancer. CA: A Cancer Journal for Clinicians, 12, 166–170.Google ScholarPubMed
Krakoff, I.H. (1979). The case for active treatment in patients with advanced cancer: Not everyone needs a hospice. CA: A Cancer Journal for Clinicians, 29, 108–111.Google Scholar
Mead, G.H. (1934). Mind, self and society: From the standpoint of a social behaviourist. Chicago: Chicago University Press.Google Scholar
Medical Oncological Group of Australia (2013). History of MOGA. Available from http://www.moga.org.au/about-moga/history-moga.Google Scholar
Meghani, S. (2004). A concept analysis of palliative care in the United States. Journal of Advanced Nursing, 46, 152–161.CrossRefGoogle ScholarPubMed
Oxford Dictionaries (2013). Available from http://www.oxforddictionaries.com/definition/english/.Google Scholar
Parish, K., Glaetzer, K., Grbich, C., et al. (2006). Dying for attention: Palliative care in the acute setting. The Australian Journal of Advanced Nursing, 24(2), 21.Google ScholarPubMed
Pincombe, J., Brown, M. & McCutcheon, H. (2003). No time for dying: A study of the care of dying patients in two acute care Australian hospitals. Journal of Palliative Care, 19, 77–86.CrossRefGoogle ScholarPubMed
Potter, J.F. (1980). A challenge for the hospice movement. The New England Journal of Medicine, 302, 53–55.CrossRefGoogle ScholarPubMed
Ramchandran, K. & von Roenn, J.H. (2013). Palliative care always. Oncology, 27, 13–16.Google Scholar
Rynearson, E.H. (1959). You are standing at the bedside of a patient dying of untreatable cancer. CA: A Cancer Journal for Clinicians, 9, 85–87.Google ScholarPubMed
Temel, J. S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363, 733–742.CrossRefGoogle ScholarPubMed
Thompson, J.F., Scolyer, R.A. & Kefford, R.F. (2009). Cutaneous melanoma in the era of molecular profiling. Lancet, 374, 362–365.CrossRefGoogle ScholarPubMed
Tieman, J.J., Sladek, R.M. & Currrow, D.C. (2009). Multiple sources: Mapping the literature of palliative care. Palliative Medicine, 23, 425–431.CrossRefGoogle ScholarPubMed
Wentlandt, K., Krzyzanowska, M.K., Swami, N., et al. (2012). Referral practices of oncologists to specialized palliative care. Journal of Clinical Oncology, 30, 4380–4386.CrossRefGoogle ScholarPubMed
White, C.D. & Hardy, J.R. (2010). What do palliative care patients and their relatives think about research in palliative care? A systematic review. Supportive Care in Cancer, 18, 905–911.CrossRefGoogle ScholarPubMed
Willard, C. & Luker, K. (2006). Challenges to end-of-life care in the acute hospital setting. Palliative Medicine, 20, 611–615.CrossRefGoogle ScholarPubMed
Wright, A.A., Zhang, B., Ray, A., et al. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. The Journal of the American Medical Association, 300, 1665–1673.CrossRefGoogle ScholarPubMed
Yabroff, K.R., Mandelblatt, J.S. & Ingham, J. (2004). The quality of medical care at the end-of-life in the U.S.A.: Existing barriers and examples of process and outcome measures. Palliative Medicine, 18, 202–216.CrossRefGoogle ScholarPubMed
Zimmermann, C., Swami, N., Krzyzanowska, M., et al. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 383, 1721–1730.CrossRefGoogle Scholar