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Communicating Care at the End of Life

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Carey Candrian

While health care at the end of life is changing, the language for talking about treatment options and patient preferences around the end of life is taking longer to change. This book carefully details the way language shapes decisions around end-of-life care. Using ethnographic research from two sites that offer emergency care and end-of-life care – a hospice and an emergency department – the author illustrates common themes around language use that serve as microcosms of the larger healthcare system in the United States. The sites have different purposes for providing care, yet the themes from both serve as guidance and reflection for other areas of caregiving.
The language used to talk about death holds consequences and opportunities for understanding and making decisions about care practices. This book uses personal stories and perspectives from patients, family members, and medical workers to paint a picture of some of the issues and tensions individuals and caregivers face. With an aging population – one that represents a major public health challenge in the twenty-first century – Carey Candrian argues that examining the care we provide for individuals, especially aging individuals, is fundamental to creating a developed, ethical, and engaged society.
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Chapter 4. Some Theories for Making Sense of Communication and Dying

Extract

Interaction is dynamic. And language, meaning, and experience are at the root of many of the problems faced by dying patients and their families (Hickman, 2002). Other individuals, organizational structures, media, and cultural environments influence us all.

Communication issues are central to discussions about how to improve care for people who are dying. Dying practices can be lonely, mechanical, and impersonal. Contrasted with a romanticized view of loved ones by the bedside, patients are now often surrounded by busy nurses, interns, residents, lab technicians, or researchers who are all strangers, mostly because they discuss the value of life in a language that makes sense in their world, a language often different from that of those who are dying.

Like patients, physicians struggle to balance straightforward communication about terminal illness. They, too, have their own fears of getting sick, or know someone who has been sick. They must also be sensitive to timing, sensitive to patient preferences, and sensitive to the accuracy of their prognoses. Above all, providers are encouraged to offer some kind of hope, even if hope is oriented to maximizing quality of life rather than extending it. (Wenrich et al., 2001). Dying and attending to the death of another person can present communication challenges for everyone involved. ← 55 | 56 →

The medical encounter has primarily been studied as an interpersonal communication event (Street, 2003). Specifically, it has focused on patterns of interaction between provider and patient, and the nature of their relationship. Understanding...

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