Older patients' attitudes towards and experiences of patient-physician end-of-life communication: a secondary analysis of interviews from British, Dutch and Belgian patients

<p>Abstract</p> <p>Background</p> <p>Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.</p> <p>Methods</p> <p>A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach.</p> <p>Results</p> <p>Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment.</p> <p>Conclusions</p> <p>A variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients’ experiences.</p

A Multiple Layer Model of Market-Oriented Organizational Culture : Measurement Issues and Performance Outcomes

Previous research addressing market orientation from a cultural perspective has typically used behavioral measures of this construct. Drawing upon literature in the fields of organizational theory and marketing, the authors develop a multi-layer model of market-oriented organizational culture. They draw an explicit distinction among values supporting market orientation, norms for market orientation, artifacts indicating high and low market orientation, respectively, and market-oriented behaviors. Based on qualitative research and a subsequent survey, scales for measuring the different layers of market-oriented culture are developed. Relationships between the different components of market-oriented culture are also analyzed. Findings indicate that artifacts play a crucial role in determining behavior within organizations. Results also indicate that a market-oriented culture influences financial performance indirectly through market performance and that this relationship is stronger in highly dynamic markets

How do surgeons experience and cope with the death and dying of their patients? A qualitative study in the context of life-limiting illnesses

BackgroundThe present qualitative study explores surgeons' experiences and coping mechanisms with the death of their patients in the context of life-limiting illnesses.MethodsNine Australian surgeons participated in in-depth interviews. Thematic analysis of the interview transcriptions allowed for identification of themes and subthemes. Methodological trustworthiness and rigor were preserved at all stages of the research process.ResultsThe essence of surgical practice, comprising participants' descriptions of their identity as surgeons, influenced their experiences and coping mechanisms when dealing with death and dying. The following subthemes were identified: distancing from patients, wanting to fix problems, doing in terms of operating on a patient, prominence of the surgeon's personal ability, and high personal responsibility for patient outcomes. Giving hope and having a mixed surgical practice were some of the coping mechanisms described by participants.DiscussionDeath and dying are a part of surgical practice, and surgeons face challenges as they care for dying patients. Although participants stated that they felt less affected by dealing with patients dying of life-limiting illnesses than by unexpected deaths, their descriptions of their encounters, reactions, and behaviors, as well as their use of language, suggest that these deaths have a lasting impact. Potential areas for improvement of surgical practice and approaches to teaching about death and dying in surgery are addressed. Furthermore, the results of this study suggest the need to expand research in this area.Sofia C. Zambrano, Anna Chur-Hansen, Gregory B. Crawfor