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Oceanic Palliative Care Conference 2023
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Concurrent Session - Ethics and Law

3:13 pm

10 September 2021

Room 2

Session Description

Session Chairs

Session Program

Background
Gaps remain in moral distress knowledge despite recent exponential growth of moral distress literature.  These gaps include moral distress experiences of Australian health professionals, and of specialist palliative care health professionals in the community setting. 

Aim
To explore empirically the moral distress experiences of Australian health professionals specialising in palliative care in community setting.

Methods
A combined ethnography and interpretative phenomenological methodology was used. The data I collected from the 70 participants included over 700 hours of general observations; in-depth interviews; observations from various meetings; informal conversations; and reflective and reflexive journaling. Chamaz’s grounded theory iterative approach guided my data analysis.

Findings
Based on the participants’ experiences, an unexplored dimension of the moral distress discourse emerged—experiences at the point of encountering challenges to moral values and moral integrity. This gave birth to the concept of Moral Equilibrium-Disequilibrium adding to the taxonomy in moral distress understanding.  Moral disequilibrium varies in intensity from mild (e.g. moral discomfort) to severe (e.g. moral distress, moral injury) and incorporates the psycho-spiritual and physical well-being of the health professional. This concept is practical to clinicians as it names the dynamic involved in facing daily moral challenges. The participants’ responses in addressing moral disequilibrium led to the development of the new Moral Equilibrium Framework (MEF) and its three dynamic phases of identification of moral disequilibrium; its resolution towards a good enough moral equilibrium; and the evolution phase of growth, building moral resilience. This research also revealed that the team as an entity can experience moral disequilibrium, hence the need to be attentive to and address it. Both the Moral Equilibrium-Disequilibrium concept and the MEF are applicable to individual health professionals and to teams. This new understanding challenges organisations to further invest in the well-being of their most important resource—the human resource. 


Background


Disclosing the truth about a patient’s diagnosis or prognosis continues to be difficult for many health professionals. However, understanding the truth is essential for patients and their families to make informed decisions about their treatment and end-of-life care. 

Aim

The research aimed to explore and examine the latest qualitative literature about how patients, families, and health professionals experienced bad news and truth disclosure during diagnostic/prognostic conversations in the inpatient/outpatient palliative care setting by conducting a qualitative meta-synthesis.

Method

The authors systematically searched for peer-reviewed, published papers between 2013 and 2020 using ‘truth disclosure,’ ‘bad news,’ and ‘palliative care or end of life care or terminal care or dying’ keywords and MeSH terms. Eight papers were analysed and synthesised using a modified meta-ethnography process.

Results

A conceptual model was developed to illustrate the findings from the synthesis, which showed two concepts: ‘Enablers in breaking bad news’ and ‘Truth avoidance/disclosure.’ The Enablers for breaking bad news concept was underpinned by several elements: the importance of the therapeutic relationship, reading cues, acknowledgment of the diagnosis/prognosis, language/delivery style, choosing an appropriate time/place, and qualities of the health professional. Although these Enablers were deemed important in creating a conducive environment to break bad news, truth avoidance could occur for many reasons including if the health professional was not comfortable or feared an emotional response. Breaking bad news is a circular, not linear, process and needs to be repeated often.

Conclusion

For patients or families to make informed decisions about end-of-life care, understanding the whole truth about their diagnosis/prognosis is necessary. Truth disclosure is an essential part of breaking bad news.
 
 
Citation for full article:
Miller, E.M., Porter, J.E., & Barbagallo, M.S. (2021). The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis. Palliative & Supportive Care, 1-12 https://www.doi.org/10.1017/S1478951521001243

 

Background


Disclosing the truth about a patient’s diagnosis or prognosis continues to be difficult for many health professionals. However, understanding the truth is essential for patients and their families to make informed decisions about their treatment and end-of-life care. 

Aim

The research aimed to explore and examine the latest qualitative literature about how patients, families, and health professionals experienced bad news and truth disclosure during diagnostic/prognostic conversations in the inpatient/outpatient palliative care setting by conducting a qualitative meta-synthesis.

Method

The authors systematically searched for peer-reviewed, published papers between 2013 and 2020 using ‘truth disclosure,’ ‘bad news,’ and ‘palliative care or end of life care or terminal care or dying’ keywords and MeSH terms. Eight papers were analysed and synthesised using a modified meta-ethnography process.

Results

A conceptual model was developed to illustrate the findings from the synthesis, which showed two concepts: ‘Enablers in breaking bad news’ and ‘Truth avoidance/disclosure.’ The Enablers for breaking bad news concept was underpinned by several elements: the importance of the therapeutic relationship, reading cues, acknowledgment of the diagnosis/prognosis, language/delivery style, choosing an appropriate time/place, and qualities of the health professional. Although these Enablers were deemed important in creating a conducive environment to break bad news, truth avoidance could occur for many reasons including if the health professional was not comfortable or feared an emotional response. Breaking bad news is a circular, not linear, process and needs to be repeated often.

Conclusion

For patients or families to make informed decisions about end-of-life care, understanding the whole truth about their diagnosis/prognosis is necessary. Truth disclosure is an essential part of breaking bad news.
 
 
Citation for full article:
Miller, E.M., Porter, J.E., & Barbagallo, M.S. (2021). The experiences of health professionals, patients, and families with truth disclosure when breaking bad news in palliative care: A qualitative meta-synthesis. Palliative & Supportive Care, 1-12 https://www.doi.org/10.1017/S1478951521001243

 

3:45 pm

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