Communication & Medicine, Vol 11, No 2 (2014)

Engaging death: Narrative and constructed dialogue in Advance Care Planning discussions

Gabriella Modan, Seuli Bose Brill
Issued Date: 17 Aug 2015

Abstract


Advance Care Planning (ACP) remains extremely low in the US, due to numerous institutional and cultural barriers and discomfort in discussing death. There is a need for guidance about how patient and healthcare providers can effectively engage in ACP discussion. Here we analyze the linguistic strategies that focus-group participants use when discussing ACP in detailed ways. Prevalent linguistic structures in effective ACP discussions were loved ones’ end-of-life narratives, hypothetical narratives, and constructed dialogue. In elucidating spontaneous, unprompted approaches to effective discussion of end-of-life issues, such research can help to dislodge communicative barriers to ACP so that more people are prepared to engage the process.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.v11i2.18616

References


Aitken, P. V. (1999) Incorporating advance care planning into family practice. American Family Physician 59 (3): 605–614, 617–620.


Baughman, K. R., Aultman, J. M., Ludwick, R. and O’Neill, A. (2014) Narrative analysis of the ethics in providing advance care planning. Nursing Ethics 21 (1): 53–63. http://dx.doi.org/10.1177/0969733013486795


Braddock, C., Edwards, K. A., Hasenberg, N. M., Laidley, T. L. and Levinson, W. (1999) Informed decision-making in outpatient practice: Time to get back to basics. Journal of the American Medical Association 282 (24): 2313–2320. http://dx.doi.org/10.1001/jama.282.24.2313


Bradley, N. M. E., Sinclair, E., Danjoux, C., Barnes, E. A., Tsao, M. N., Farhadian, M., Yee, A. and Chow, E. (2006) The do-not-resuscitate order: incidence of documentation in the medical records of cancer patients referred for palliative radiotherapy. Current Oncology 13 (2): 47–54.


Bruner, J. (1986) Actual Minds, Possible Worlds. Cambridge, MA: Harvard University Press.


Bunker, J. P. (2001) The role of medical care in contributing to health improvements within societies. International Journal of Epidemiology 30 (6): 1260–1263. http://dx.doi.org/10.1093/ije/30.6.1260


Byers, J. F. and Melhado, L. (2011) Patients’ and surrogates’ decision-making characteristics: Withdrawing, withholding, and continuing life-sustaining treatments. Journal of Hospice and Palliative Nursing 13 (1): 16–28. http://dx.doi.org/10.1097/NJH.0b013e3182018f09


Castillo, L. S., Williams, B. A., Hooper, S. M., Sabatino, C. P., Weithorn, L. A. and Sudore, R. L. (2011) Lost in translation: The unintended consequences of advance directive law on clinical care. Annals of Internal Medicine 154 (2): 121–128. http://dx.doi.org/10.7326/0003-4819-154-2-201101180-00012


Chapple, A., Ziebland, S., Mcpherson, A. and Herxheimer, A. (2006). What people close to death say about euthanasia and assisted suicide: A qualitative study. Journal of Medical Ethics 32 (12): 706–710. http://dx.doi.org/10.1136/jme.2006.015883


Cheshire, J. and Ziebland, S. (2005) Narrative as a resource in accounts of the experience of illness. In J. Thornborrow and J. Coates (eds) The Sociolinguistics of Narrative, 17–40. Amsterdam: Benjamins. http://dx.doi.org/10.1075/sin.6.02che


Clark, H. H. and Gerrig, R. J. (1990) Quotations as demonstratives. Language 66 (4): 764–805. http://dx.doi.org/10.2307/414729


Coolen, P. (2012) Cultural relevance in end of life care. Ethnomed. Retrieved from: https://ethnomed.org/clinical/end-of-life/cultural-relevance-in-end-of-life-care


Curd, P. R. (1999) Advance care planning reconsidered: Toward an operational definition of outpatient advance care planning. Journal of Palliative Medicine 2 (2): 157–159. http://dx.doi.org/10.1089/jpm.1999.2.157


Curtis, J. R. (2011) Reimbursement for advance care planning: Why should intensivists care? American Journal of Respiratory Critical Care Medicine 184 (4): 387–388. http://dx.doi.org/10.1164/rccm.201106-0981ED


Davies, B. and Harré, R. (1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behavior 20 (1): 43–63. http://dx.doi.org/10.1111/j.1468-5914.1990.tb00174.x


Detering, K. M., Hancock, A. D., Reade, M. C. and Silvester, W. (2010) The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. British Medical Journal 340 c.1345. http://dx.doi.org/10.1136/bmj.c1345


Drought, T. S. (2000). The Discourse of Advance Care Planning: End-of-life Decision-Making in a Multicultural Population of Oncology and AIDS Patients. Unpublished doctoral dissertation, University of California, San Francisco.


Drought, T. S. and Koenig, B. A. (2002) ‘Choice’ in end-of-life decision-making: Researching fact or fiction? Gerontologist 42 (Special issue 3): 114–128.


Elwyn, G., Edwards, A. and Kinnersley, P. (1999) Shared decision-making in primary care: The neglected second half of the consultation. British Journal of General Practice 49 (443): 477–482.


Emanuel, L. L., Danis, M., Pearlman, R. A. and Singer, P. A. (1995) Advance care planning as a process: Structuring the discussions in practice. Journal of the American Geriatric Society 43 (4): 440–446. http://dx.doi.org/10.1111/j.1532-5415.1995.tb05821.x


Fairman, R. (1992) Withdrawing life-sustaining treatment: Lessons from Nancy Cruzan. Archives of Internal Medicine 125 (1): 25–27. http://dx.doi.org/10.1001/archinte.1992.00400130051003


Field, M. J. and Cassel, C. K. (1997) Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Press.


Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania Press.


Gordy, S. and Klein, E. (2011) Advance directives in the trauma intensive care unit: Do they really matter? International Journal of Critical Illness and Injury Science 1 (2): 132–137. http://dx.doi.org/10.4103/2229-5151.84800


Gramling, D. and Gramling, R. (2012) Laughing at the dark: Tactical humor for autonomous decision-making in serious illness. Journal of Palliative Medicine 15 (11): 1170–1172. http://dx.doi.org/10.1089/jpm.2012.0279


Greco, P. J., Schulman K. A., Lavizzo-Mourey. R. and Hansen-Flaschen, J. (1991) The Patient Self-Determination Act and the future of advance directives. Annals of Internal Medicine 115 (8): 639–643. http://dx.doi.org/10.7326/0003-4819-115-8-639


Green, M. J. and Levi, B. H. (2009) Development of an interactive computer program for advance care planning. Health Expectations 12 (1): 60–69. http://dx.doi.org/10.1111/j.1369-7625.2008.00517.x


Hamilton, H. E. (1998) Reported speech and survivor identity in on-line bone marrow transplanation narratives. Journal of Sociolinguistics 2 (1): 53–67. http://dx.doi.org/10.1111/1467-9481.00030


Hammes, B. J., Rooney, B. L. and Gundrum, J. D. (2010) A comparative, retrospective, observational study of the prevalence, availability, and specificity of advance care plans in a county that implemented an advance care planning microsystem. Journal of the American Geriatric Society 58 (7): 1249–1255. http://dx.doi.org/10.1111/j.1532-5415.2010.02956.x


Heyland, D. K., Allan D. E., Rocker, G., Dodek, P., Pichora, D., Gafni, A. and Canadian Researchers at the End-of-Life Network (CARENET). (2009) Discussing prognosis with patients and their families near the end of life: Impact on satisfaction with end-of-life care. Open Med 3 (2): e101–110.


Hiltunen, E. F., Medich, C. S., Peterson, L. and Forrow, L. (1999) Family decision making for end-of-life treatment: The SUPPORT nurse narratives. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Journal of Clinical Ethics 10 (2): 126–134.


Hoffmann, D. E., Zimmerman, S. I. and Tompkins, C. J. (1996) The dangers of directives or the false security of forms. Journal of Law, Medicine & Ethics (24) 1: 5–17. http://dx.doi.org/10.1111/j.1748-720X.1996.tb01829.x


Holt, E. (2000) Reporting and reacting: Concurrent responses to reported speech. Research on Language and Social Interaction 33 (4): 425–454. http://dx.doi.org/10.1207/S15327973RLSI3304_04


In der Schmitten, J., Rothärmel, S., Mellert, C., Rixen, S., Hammes, B. J., Briggs, L., Wegscheider, K. and Marckmann, G. (2011) A complex regional intervention to implement advance care planning in one town’s nursing homes: Protocol of a controlled inter-regional study. BMC Health Services Research 11: 14. http://dx.doi.org/10.1186/1472-6963-11-14


Johnstone, B. (1990) Stories, Community and Place: Narratives from Middle America. Bloomington: Indiana University Press.


Karel, M. J., Powell, J. and Cantor, M. D. (2004) Using a Values Discussion Guide to facilitate communication in advance care planning. Patient Education and Counseling 55 (1): 22–31. http://dx.doi.org/10.1016/S0738-3991(03)00246-5


Kass-Bartelmes, B. L. and Hughes, R. (2004) Advance care planning: Preferences for care at the end of life. Journal of Pain & Palliative Care Pharmacotherapy, 18 (1): 87–109. http://dx.doi.org/10.1080/j354v18n01_08


Kwak, J. and Haley, W. E. (2005) Current research findings on end-of-life decision-making among racially or ethnically diverse groups. Gerontologist 45 (5): 634–641. http://dx.doi.org/10.1093/geront/45.5.634


Labov, W. (1972) Language in the Inner City. Philadelphia: University of Pennsylvania Press.


Labov, W. and Fanshel, D. (1977) Therapeutic Discourse: Psychotherapy as Conversation. New York: Academic Press.


Lee, M. A., Brummel-Smith, K., Meyer, J., Drew, N. and London, M. R. (2000) Physician orders for life-sustaining treatment (POLST): Outcomes in a PACE program. Program of All-Inclusive Care for the Elderly. Journal of the American Geriatric Society 48 (10): 1219–1225. http://dx.doi.org/10.1111/j.1532-5415.2000.tb02594.x


Levi, B. H. and Green, M. J. (2010) Too soon to give up? Re-examining the value of advance directives. American Journal of Bioethics 10 (4): 3–22. http://dx.doi.org/10.1080/15265161003599691


Lipkin, K. M. (2006) Brief report: Identifying a proxy for health care as part of routine medical inquiry. Journal of General Internal Medicine 21 (11): 1188–
1191. http://dx.doi.org/10.1111/j.1525-1497.2006.00570.x


Lo, B. and Steinbrook, R. (1991) Beyond the Cruzan case: The U.S. Supreme Court and medical practice. Annals of Internal Medicine 114 (10): 895–901. http://dx.doi.org/10.7326/0003-4819-114-10-895


Long, H. W. (1979) Investment decision-making in the health care industry: The future. Health Services Research 14 (3): 183–205.


Marchand, L., Fowler, K. J. and Kokanovic, O. (2006) Building successful coalitions for promoting advance care planning. American Journal of Hospice and Palliative Care 23 (2): 119–126. http://dx.doi.org/10.1177/104990910602300209


McIntyre, R. L. (1993) The significance of the legacy of Karen Ann Quinlan. Trends in Health Care Law Ethics 8 (1): 7–16.


Modan, G. G. (2007) Turf Wars: Discourse, Diversity, and the Politics of Place. Malden, MA: Blackwell. http://dx.doi.org/10.1002/9780470773970


Morrison, R. S., Olson, E., Mertz, K. R. and Meier, D. E. (1995) The inaccessibility of advance directives on transfer from ambulatory to acute care settings. Journal of the American Medical Association 274 (6): 478–482. http://dx.doi.org/10.1001/jama.1995.03530060052033


Myers, G. (1999) Unspoken speech: Hypothetical reported discourse and the rhetoric of everyday talk. Text 19 (4): 571–590. http://dx.doi.org/10.1515/text.1.1999.19.4.571


Nicholas, J. A. and Hall, W. J. (2011) Screening and preventive services for older adults. Mt Sinai Journal of Medicine 78 (4): 498–508. http://dx.doi.org/10.1002/msj.20275


NHS Improving Quality. (2014) Planning For Your Future Care: A Guide. Retrieved from: http://www.nhs.uk/Planners/end-of-life-care/Documents/planning_for_your_future_updated_sept_2014%20(1).pdf


Parry, R., Land, V. and Seymour, J. (2014) How to communicate with patients about future illness progression and end of life: A systematic review. BMJ Supportive and Palliative Care 4 (4): 331-341. http://dx.doi.org/10.1136/bmjspcare-2014-000649


Perry, J. E., Churchill, L. R. and Kirshner, H. S. (2005) The Terri Schiavo case: Legal, ethical, and medical perspectives. Annals of Internal Medicine 143 (10): 744–748. http://dx.doi.org/10.7326/0003-4819-143-10-200511150-00012


Ramsaroop, S. D., Reid, M. C. and Adelman, R. D. (2007) Completing an advance directive in the primary care setting: What do we need for success? Journal of the American Geriatrics Society 55 (2): 277–283. http://dx.doi.org/10.1111/j.1532-5415.2007.01065.x


Sabatino, C. P. (2010) The evolution of health care: Advance planning law and policy. Milbank Quarterly 88 (2): 211–239. http://dx.doi.org/10.1111/j.1468-0009.2010.00596.x


Schely-Newman, E. (2009) Defining success, defending failure: Functions of reported talk. Research on Language and Social Interactions 42 (3): 191–209. http://dx.doi.org/10.1080/08351810903089142


Schiffrin, D. (1996) Narrative as self-portrait: Sociolinguistic constructions of identity. Language in Society 25 (2): 167–203. http://dx.doi.org/10.1017/S0047404500020601


Shalowitz, D. I., Garrett-Mayer, E. and Wendler, D. (2006) The accuracy of surrogate decision-makers: A systematic review. Archives of Internal Medicine 166 (5): 493–497. http://dx.doi.org/10.1001/archinte.166.5.493


Simmons, K. and LeCouteur, A. (2011) ‘Hypothetical active-voicing’: Therapists ‘modelling’ of clients’ future conversations in CBT interactions. Journal of Pragmatics 43 (13): 3177–3192. http://dx.doi.org/10.1016/j.pragma.2011.06.002


Simpson, C. (2012) Advance care planning in COPD: Care versus ‘code status’. Chronic Respiratory Disease 9 (3): 193–204. http://dx.doi.org/10.1177/1479972312445897


Steinhauser, K., Christakis, N., Clipp, E., Mcneilly, M., Mcintyre, L. and Tulsky, J. (2000) Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA 284 (19): 2476–2482. http://dx.doi.org/10.1001/jama.284.19.2476


Stiggelbout, A. M., Molewijk, A. C., Otten, W., Timmermans, D. R., van Bockel, J. H. and Kievit, J. (2004) Ideals of patient autonomy in clinical decision-making: a study on the development of a scale to assess patients’ and physicians’ views. Journal of Medical Ethics 30 (3): 268–274. http://dx.doi.org/10.1136/jme.2003.003095


Tannen, D. (1989) Talking Voices: Repetition, Dialogue and Imagery in Conversational Discourse. Cambridge: Cambridge University Press.


Temel, J. S., Greer, J. A., Sonal, A., Solis, J., Cashavelly, B. J., Doherty, S., Heist, R. and Pirl, W. F. (2010) Code status documentation in the outpatient electronic medical records of patients with metastatic cancer. Journal of General Internal Medicine 25 (2): 150–153. http://dx.doi.org/10.1007/s11606-009-1161-z


Teno, J. M. (1999) Lessons learned and not learned from the SUPPORT project. Palliative Medicine 13 (2): 91–93. http://dx.doi.org/10.1191/026921699671270463


Teno, J. M., Gruneir, A., Schwartz, Z., Nanda, A. and Wetle, T. (2007) Association between advance directives and quality of end-of-life care: A national study. Journal of the American Geriatric Society 55 (2): 189–194. http://dx.doi.org/10.1111/j.1532-5415.2007.01045.x


Teno, J. M., Licks, S., Lynn, J., Wenger, N., Connors, A. F., Phillips, R. S., O’Connor, M. A., Murphy, D. P., Fulkerson, W. J., Desbiens, N. and Knaus, W. A. (1997) Do advance directives provide instructions that direct care? Journal of the American Geriatric Society 45 (4): 508–512. http://dx.doi.org/10.1111/j.1532-5415.1997.tb05179.x


Vasquez, C. and Urzúa, A. (2009) Reported speech and reported mental states in mentoring meetings: Exploring novice teacher identities. Research on Language and Social Interaction 42 (1): 1–19. http://dx.doi.org/10.1080/08351810802671693


Weiner, J. S. and Cole, S. A. (2004) Three principles to improve clinician communication for advance care planning: Overcoming emotional, cognitive, and skill barriers. Journal of Palliative Medicine 7 (6): 817–829. http://dx.doi.org/10.1089/jpm.2004.7.817


Wilkinson, A., Wenger, N., and Shugarman, L. R. (2007) Literature Review on Advance Directives. Washington, DC: US Department of Health and Human Services.


Witkowski, E., Vanstraelen, E., De Moor, B. and Hardy, F. (2007) The need for care co-ordination in an aging dialysis population. Journal of Renal Care 33 (1): 39–40. http://dx.doi.org/10.1111/j.1755-6686.2007.tb00036.x


Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. E., Maciejewski, M. L., Earle, C. C., Block, S. D., Maciejewski, P. K. and Prigerson, H. G. (2009) Health care costs in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine 169 (5): 480–488. http://dx.doi.org/10.1001/archinternmed.2008.587


Refbacks

  • There are currently no refbacks.





Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email: info@equinoxpub.com

Privacy Policy