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In palliative care, health professionals provide support and care for patients for the duration of the unknown time toward death. While the experiences of patients diagnosed with a life limiting illness in palliative care have received some scholarly attention, little research has explored these experiences as described by palliative inpatients themselves. The purpose of this article is to explore how patients describe their lived experiences of time while in a palliative inpatient facility.
Methods:
This study used a qualitative phenomenological method and nine inpatients were recruited. They were interviewed utilizing in-depth semi-structured interviews, which were audio taped and transcribed. These interview transcripts of their descriptions were the data sources for this inquiry. Their description is part of a broader phenomenological inquiry on the experience of living with a life limiting illness described by palliative inpatients. Data were analyzed to identify essential themes within and across cases.
Results:
Three essential themes were revealed: “brief time”; “waiting time,” and “transcendental horizon: future time.” These themes were not mutually exclusive and participant's experiences of time approaching death were described as a time of living toward death.
Significance of results:
The findings suggest that patients diagnosed with a life limiting illness have multi-dimensional experiences of time. Understanding the experiences of temporality for patients close to the gravity of death, from the patients' own words, can provide direction for patient informed interventions in clinical practice.
This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering.
Method:
Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews.
Results:
In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness.
Significance of results:
The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.
Ordinarily, when discussing treatment options with a patient, doctors manage to fulfill an ethical obligation by ensuring that the patient's treatment choices are accommodated as far as possible. The four key ethical principles are: beneficence, non-maleficence, respect for autonomy, and justice. One of the cornerstones of good medical practice is that before providing treatment or involving a patient in teaching, or research, doctors must be satisfied that they have a valid authority. Usually this requires the patient to consent to the proposed treatment. In critical care the hardest decisions are those concerning when to withhold or withdraw treatment. Despite this the majority of patients who die in critical care departments do so after a decision to withhold or withdraw life-prolonging care. When considering end-of-life issues, good communication with patients and their relatives is essential for establishing priorities and ensuring that the wishes of the patient are paramount.
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