ORCID Profile
0000-0003-4542-6163
Current Organisations
City, University of London
,
Loughborough University
,
University of York
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Publisher: Springer Science and Business Media LLC
Date: 08-12-2021
DOI: 10.1186/S12904-021-00876-2
Abstract: There is growing recognition that a erse range of healthcare professionals need competence in palliative approaches to care. Effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions. The current rapid review updates findings of a 2014 systematic review, focussing more specifically on evidence related to illness progression and end-of-life conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies. Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in discussions about illness progression and end-of-life. The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life.
Publisher: National Institute for Health and Care Research
Date: 12-2022
DOI: 10.3310/FPFP4621
Abstract: NHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time. Our objectives were as follows – create a data set of video- and audio-recordings of labour and birth in midwife-led units use conversation analysis to explore how talk is used in shared decision-making assess whether or not women’s antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with women’s postnatal satisfaction and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice. This was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions, which were explored alongside questionnaire data concerning women’s antenatal expectations and preferences, and women’s experiences of, and postnatal satisfaction with, decision-making. Semistructured interviews with health-care practitioners explored factors shaping decision-making. The study took place in midwife-led units at two English NHS trusts. A total of 154 women (aged ≥ 16 years with low-risk pregnancies), 158 birth partners and 121 health-care practitioners consented to be recorded. Of these participants, 37 women, 43 birth partners and 74 health-care practitioners were recorded. Midwives initiate the majority of decisions in formats that do not invite women’s participation (i.e. beyond consenting). The extent of optionality that midwives provide varies with the decision. Women have most involvement in decisions pertaining to pain relief and the third stage of labour. High levels of satisfaction are reported. There is no statistically significant relationship between midwives’ use of different formats of decision-making and any measures of satisfaction. However, women’s initiation of decisions, particularly relating to pain relief (e.g. making lots of requests), is associated with lower satisfaction. Our data set is explored with a focus on decision initiation and responses, leaving other important aspects of care (e.g. midwives’ and birth partners’ interactional techniques to facilitate working with pain) underexplored, which might be implicated in decision-making. Despite efforts to recruit a erse s le, ethnic minority women are under-represented. Policy initiatives emphasising patient involvement in decision-making are challenging to enact in practice. Our findings illustrate that women are afforded limited optionality in decision-making, and that midwives orient to guidelines/standard clinical practice in pursuing particular decisional outcomes. Nonetheless, the majority of women were satisfied with their experiences. However, when women needed to pursue decisions, particularly concerning pain relief, satisfaction is lower. Conversation analysis demonstrates that such ‘women-initiated’ decision-making occurs in the context of midwives’ avoiding pharmacological methods of pain relief at particular stages of labour. We suggest that future research address the following – the barriers to inclusion of ethnic minority research participants, decision-making in obstetric units, systematic understanding of how pain relief decisions are pursued/resolved, conversation analysis of interactional elements beyond the specific decision-making context, interactional ‘markers’ of the emotional labour and inclusion of antenatal encounters. This trial is registered as ISRCTN16227678 and National Institute for Health and Care Research (NIHR) CRN Portfolio (CMPS):32505 and IRAS:211358. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research Vol. 10, No. 36. See the NIHR Journals Library website for further project information.
Publisher: Cold Spring Harbor Laboratory
Date: 05-2020
DOI: 10.1101/2020.04.27.20078048
Abstract: Pandemics pose significant challenges for healthcare systems, including an increase in difficult discussions about future illness progression and end of life. To synthesise existing evidence about communication practices used to discuss difficult matters, including prognosis and end of life, and to use this evidence to make recommendations for clinical practice. The aim of this study was to use rapid review methods to update findings from a previous systematic review published in 2014. MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science, Scopus, ASSIA and Amed. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about difficult matters relating to future illness progression and end of life. Data appraisal and extraction procedures used in the 2014 review were modified for this rapid review. Following screening, 18 sources were deemed to meet eligibility criteria, which were added to the 19 sources included in the 2014 systematic review. Synthesis of study findings identified 11 communication practices: providing opportunities for patient or family members to propose matters to discuss (7 out of 37 included sources) seeking a patient or family member’s perspective (6/37) discussing the future indirectly (11/37) discussing the future explicitly (7/37) linking to something previously said or done (11/37) using hypothetical scenarios (13/37) framing a difficult matter as universal (5/37) acknowledging uncertainty (3/37) exploring options (2/37) displaying sensitivity (7/37) emphasising the positive (7/37). Dividing work amongst the study authors to enable rapid review may have created inconsistencies. This synthesis of high-quality evidence from actual clinical practice supports a series of recommendations for communicating about difficult matters during and beyond the COVID-19 pandemic.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Victoria Land.