multiple professional visions and inter- professional communication at the end-of- life: challenges...
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Multiple Professional Visions and Inter-Professional Communication at the End-Of-Life: Challenges for Swiss Doctors
Chiara Piccini, Antonella Carassa,Vanessa Alvarado, Brigitte Liebig
Piccini, Carassa, Alvarado & Liebig 2
The Project
• NRP 67: End-Of-Life (SNF, 2011-2017)
• Project: Decision-Making in General Practice Settings at the End of Life (2012-2014)
Piccini, Carassa, Alvarado & Liebig 3
Research Questions
What is the role of inter-professional communication in end-of-life decision making?
Which are the main challenges?
Which are the possible strategies to face the perceived challenges?
Piccini, Carassa, Alvarado & Liebig 4
Theoretical Framing
• Inter-professional collaboration is a qualitative indicator of end-
of-life palliative care (Kauss et al. 1998, Binder/Wartburg 2009)
• Good communication practices as a condition of collaboration
• Inter-relationship between institutional framework (resources
and constraints) and communication practice (Piccini/Carassa/Colombetti 2006)
• Professional visions (Godwin 1994) and communities of practice (Wenger 1998)
Piccini, Carassa, Alvarado & Liebig 5
Methods
• Case studies in 3 language regions of Switzerland, Expert
Questionnaires, Expert Interviews
• Group discussions: 91 Family Doctors (FDs), 72 nurses, and 21
relatives
• Qualitative analysis of data, Grounded Theory (Glaser/Strauss,
1974)
• Perspectives of FDs, nurses, and relatives have been triangulated
Piccini, Carassa, Alvarado & Liebig 6
Overview of Results
Piccini, Carassa, Alvarado & Liebig 7
Findings
• Relevant information to make decisions appears to be fragmented
• Fragmented information challenges the quality of care at the end-of-life
loss of decision making quality unreasonable aggressive treatments and painful death
• Spontaneous non-institutional communicative strategies prevent fragmentation of information
Piccini, Carassa, Alvarado & Liebig 8
Discussion
• Communication practices rely on interpersonal relationship and the
strategies are not elaborated enough with respect to defined
processes
This is critical in a globalized multicultural context, characterized also by
frequent professional mobility
• A more flexible retribution system for doctors and arrangements in
hospitals work organization may be useful
Development of collaboration practices and alignment between visions
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