Article Text

Download PDFPDF

Oral Abstracts - Home Care/Age Care
A framework for finding common ground with substitute decision-makers to achieve a patient's good death
  1. A Tan1 and
  2. D Manca1
  1. 1Dept Of Family Medicine, University of Alberta


Conflict with substitute decision-makers of dying patients is not uncommon in end-of-life care. Understanding how to best manage these conflicts may improve relationships between physicians and substitute decision-makers, reduce stress, and ultimately improve the care of dying patients. To gain insight, we explored the experiences of Canadian Family Physicians who encountered conflict with a substitute decision-maker of a dying patient. We employed a Grounded Theory methodology with in-depth, semi-structured, audiotaped interviews about recent experiences of conflict. Purposeful sampling sought a maximum sample variation for physician participants. The verbatim transcripts, field notes and project memos were analysed using an iterative process involving the constant-comparative method to identify emerging key themes and concepts. Our study found that the physicians' main concern was for the patient to have a death free from avoidable distress, and in accord with the patient's wishes. A framework for achieving a “good death” through Finding Common Ground is described. This process involves: 1) building trust through clarifying roles, bringing key players together and delivering small bits of information at a time; 2) understanding through active listening, and finally; 3) informed shared decision-making. Preliminary findings also describe barriers to achieving Common Ground and what to do when an impasse occurs. This presentation will describe a framework for developing Common Ground between Family Physicians and substitute decision-makers to assist in achieving a “good death”. Discussion of these primary results may help physicians, allied healthcare professionals, learners, and the public, improve end-of-life decision-making.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.