A decision you can live with: Third party experiences with family conflict during end of life

Abstract

The importance of end-of-life discussions has been brought to the attention of the public, the medical community, and the government. This study sought to explore the roles and experiences of individuals who are highly involved with family discussions, using organizational conflict processes as a lens. The data consisted of in-depth semi-structured interviews with nurses, patient advocates, clergy, chaplains and administrators (n = 78). These organizational members constitute naïve third party conflict practitioners because they are engaged in the work of managing conflict but typically lack of training in formal dispute resolution. The participants use four Rs in managing conflict with families – refocusing, reframing, referring, and reconciling. These styles focus on the family and the patient, and participants suggest that strategies that are obliging or accommodating are more appropriate than collaboration, avoidance, or compromising. These findings challenge traditional notions of collaboration as the most effective conflict management strategy in organizations. This study also identifies some of the problems embedded in end-of-life situations that may cause difficulties for the family and medical staff. Furthermore, the study suggests that mandating end of life documentation may not be an effective strategy; instead, policy should mandate support funding and conflict resolution training for healthcare professionals