Aims To qualitatively explore staff members’ experiences of discussing preferred place of death (PPD) with patients at the Marie Curie Hospice Edinburgh (MCHE).
Introduction National end-of-life care policies propose that health-care professionals should have regular end-of-life discussions with patients wishing to talk about such issues. In 2007 the process of identifying patient end-of-life preferences was formalised at the MCHE; and staff now routinely discuss and record PPD. This study explores staff experiences of these discussions.
Method Six members of medical and nursing staff were recruited from the inpatient, day-service and community teams at the MCHE. Participants took part in an in-depth, audio-recorded, semi-structured interview. Interviews were transcribed verbatim and analysed using Interpretative Phenomenological Analysis (IPA), an approach to phenomenology which aims to capture and understand lived experience.
Results Four themes were identified as being integral to participants’ accounts: “The importance of discussing preferences at the end of life”- staff recognise the importance of discussing and trying to achieve patients’ final wishes; “Identifying how and when to discuss PPD”- staff identify cues from patients to ensure discussions occur at a time and pace suitable for the individual; “Reflecting on the emotional aspects of discussing PPD”- discussing PPD is challenging but important and rewarding; “A journey from expectations to experience”- discussing PPD becomes easier over time through practice and learning from others.
Conclusion These findings highlight that although PPD discussions can be difficult, staff feel that discussing future plans, including place of death, with patients is important and beneficial for both patients and their families. With time, staff members have developed communication strategies that allow them to discuss PPD in an effective, sensitive and patient-centred way.
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