Cancer patients’ care at the end of life in a critical care environment : Perspectives of families, patients and practitioners

Pattinson, Nicola, Carr, Susan, Turnock, Chris and Dolan, Shelley (2011) Cancer patients’ care at the end of life in a critical care environment : Perspectives of families, patients and practitioners. In: RCN Annual International Nursing Research Conference, 16-18 May 2011, Harrogate.

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Abstract

Background:
End-of-life care (EOLC) for critically ill patients, of whom 20% will die in critical care, remains somewhat problematic (Truog et al, 2008). EOLC is an established domain in cancer; however research has not been conducted previously into dying, critically ill cancer patients’ experiences.

Aim:
To explore EOLC experiences of critically ill cancer patients, families, oncologists, palliative care specialists, critical care consultants and nurses.

Methods:
Heideggerian hermeneutic phenomenology was used to explore experiences of thirty-seven participants: patients (and families) (n=13), families of patients who had died (n=6), oncologists (n=2), palliative care consultants (n=2), critical care consultants (n=7), critical care nurses and critical care consultants in a UK specialist critical care unit from Jan 2007-Jan 2008. Purposive sampling was used. Interviews were taped, transcribed and analysed using Heideggerian phenomenological principles and Van Manen’s (1990) phenomenological analysis framework.

Results:
A phenomenological description of a continuum of dying in cancer critical illness, and impact on opportunities for EOLC, will be presented with different participant experiences along that continuum. Three main themes included: Dual Prognostication; The Meaning of Decision Making; and Care Practices at EOL: Choreographing a Good Death, with two sub-themes: Thinking the Unthinkable and Involvement in Care. EOLC was an emotive experience for all participants and core tenets for good EOLC included comfort, less visible technology, privacy and dignity. These findings will be discussed in relation to EOLC and critical illness.

Discussion:
This work builds on Seymour’s (2001) theory of negotiated and natural dying around achieving good death in critical care.

Conclusion:
The practice implication of this study shows how nurses could use the care of patients dying in critical care as an opportunity to develop specialist knowledge and lead in care, but this requires mastery and reconciliation of both technology and EOLC. The cancer model of EOLC needs translating into critical care.

Item Type: Conference or Workshop Item (Paper)
Subjects: B700 Nursing
Department: Faculties > Health and Life Sciences > School of Health, Community and Education Studies > Nursing, Midwifery and Health
Depositing User: Ellen Cole
Date Deposited: 18 Dec 2012 14:48
Last Modified: 10 Aug 2015 11:38
URI: http://nrl.northumbria.ac.uk/id/eprint/10890

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