End of life care provision : the influence of broader discursive formations

Atkinson, Joanne, Lhussier, Monique and Carr, Susan (2016) End of life care provision : the influence of broader discursive formations. In: 11th Palliative Care Congress Rediscovering Holism: the future for Palliative Care, 9th - 11th March, Glasgow.

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Abstract

Background
This study examines the discursive tendencies impacting on end of life care practice in the hospital setting. Practice is influenced by two major and sometimes conflicting issues. Firstly, the demands of policy and practice drivers to apply tools (apparatus) across differing care settings make little reference to the broader cultural influences on delivery. Secondly, recent years have seen unprecedented media interest in end of life care, and the emergence of powerful discourses that influence health care professionals delivering care. This work focusses on the tensions, challenges and possibilities that emerge from this intersection.
Aim
To explore the influence and impact of emerging, competing and overlapping discourses on practice in end of life care.
Methodology
Discourse analysis is a collection of methodological approaches, which attempt to link linguistic, socio-cultural and historical aspects of a field of study. Analysing discourses provides a route to better understanding of the challenges and philosophy of care at the end of life.
Methods
Collection and analysis of artefacts from journalistic press and terrestrial television (factual outputs) was undertaken. Tape-recorded narratives were taken from four consultants and six clinical nurse specialists working in palliative care, and a cancer centre. Participants recorded the narratives over a two-week period. Guidance was given regarding the aim of the study and length of narratives varied from ten minutes to two hours.

Findings
The media artefacts and narratives have reaffirmed the metaphorical language utilised when discussing end of life care, and highlighted the impact that the sensationalisation of end of life care has on practice, instilling a moral panic that both disables and fuels the need for change.
Prominent discursive formations include:
Professional Apparatus
Technologies of Caring
Technologies of Self
Technologies of Power
Technologies of Representation
This presentation will detail their role, impacts and overlaps.

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