Communicating Spirituality, Dying and a “Good Death” at the End-of-Life: The Role of Hospice Interdisciplinary Team Members

Hospices use interdisciplinary teams to aid patients and families as they cope with the imminence of death while helping them achieve a death free of physical and spiritual pain, also known as a good death. This study investigated the communication between hospice team members and their patients regarding spirituality, dying, death and a good death. Through 300 hours of participant observation and interviews with hospice staff at one large not-for-profit hospice in the Southeastern United States this project shows that team members understand patient\u27s spirituality through a religious frame potentially compromising spiritual care. Talk between patients and their care team rarely focuses on what constitutes a good death and team members eventually come to narrate all hospice deaths as good

What Would Nick T. Do?: Lessons from a Mentor

Mentors influence their mentees in ways that not only shape them as professionals but also as people. In this essay, we draw upon our personal experiences with Professor Nick Trujillo, who died unexpectedly in October 2012, to describe the ways we were influenced by our relationships. We include the story of a last visit three weeks before his death, an interlude, and six lessons that chart the trajectory of our journeys as students, friends, and colleagues

Resisting the Hospice Narrative in Pursuit of Quality of Life

The overall hospice philosophy is to provide care that enhances a dying person’s quality of life. Most individual’s quality of life is improved when they embrace hospice eligibility and reimbursement requirements, such as stopping burdensome and ineffective curative treatment, addressing pain and other symptoms, and seeking avenues for closure. However, this institutionalized prescription for enhancing quality of life at the end of life does not work for all patients. This article considers what happens when patients’ personal definitions of quality of life at the end of life resist the prevailing narrative of appropriate hospice care. Using a series of examples from more than 600 hours of participant observation, our findings reveal narratives of resistance that fall into three themes: i) patients and/or family members who deny the imminence of death despite an admission to hospice; ii) patients who request treatments usually defined as curative; and iii) patients who resist the organizational constraints imposed by the institutionalization of the hospice model of care. Analysis of these themes illustrates the subjective nature of quality of life at the end of life and the pressures of standardization that may accompany the growth and maturity of the hospice industry in the United States

Beyond Good Intentions and Patient Perceptions: Competing Definitions of Effective Communication in Head and Neck Cancer Care at the End of Life

Effective communication between dying cancer patients and their health care providers about prognosis and treatment options ensures informed decision making at the end of life. This study analyzed data from interviews with end-stage head and neck cancer patients and their health care providers about communication competence and approaches to communicating about end-of-life issues. Patients rated their oncologists as competent and comfortable discussing end-of-life issues, although few reported discussing specific aspects of end-of-life care. Oncologists viewed giving prognostic information as a process rather than a singular event, and preferred answering patients’ questions as opposed to guiding the discussion. These data reveal subtle disconnects in communication suggesting that patients’ and health care providers’ information needs are not being met

The Meaning of Everything: Communication at the End of Life

Communication about end-of-life care is increasingly recognized as a core clinical skill, but doctors are often unprepared to have these conversations. Crisis situations at the end of life, such as when a hospitalized patient with a poor prognosis requests that “everything” be done, pose even greater communicative challenges. Such decisions are often regarded as a demand for care that may be burdensome or even harmful, rather than the start of an important conversation about values and goals. Situations such as this have prompted the development of prescriptive approaches to communicating with patients, which have limitations since they focus more on the physicians’ message than on developing a relationship with the patient or eliciting the meaning of the illness and its treatment. Current models of communication are less about accurate transmission of information and more about the ways in which communication constitutes our social world. Thus, the goal of communication training for physicians should be less about tools and scripts, and more about doctors learning to engage patients in conversation. We suggest strategies for promoting dialogue to more effectively explore the concerns and misunderstandings that might underlie decisions to “do everything.

Truth Troubles

“truth” is an issue of public discussion, research, and everyday performance. Processes of navigating truth, however, are obscure and often unknown. In this project, the authors highlight truth(s) of written life texts. They conceive of truth as a rather than the “rhetorical device” to use for evaluating personal research and believe that demanding factual, historical truth-of-life research is faulty and problematic. By illustrating how genre, trust, memory, and confession influence truth telling, the authors hope to question and enhance truth-related conversations