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Dying cancer patients talk about physician and patient roles in DNR decision making.
- Source :
- Health Expectations; Jun2011, Vol. 14 Issue 2, p147-158, 12p
- Publication Year :
- 2011
-
Abstract
- Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. [ABSTRACT FROM AUTHOR]
- Subjects :
- CARDIOPULMONARY resuscitation
DO-not-resuscitate orders
ACADEMIC medical centers
ANALYSIS of variance
CANCER patient psychology
DECISION making
DISCOURSE analysis
INTERVIEWING
MATHEMATICAL models
RESEARCH methodology
PATERNALISM
PATIENTS
PHYSICIAN-patient relations
PHYSICIANS
RESEARCH funding
PSYCHOLOGY of the sick
SOUND recordings
PSYCHOLOGY of the terminally ill
PATIENT participation
DECISION making in clinical medicine
QUALITATIVE research
THEORY
OCCUPATIONAL roles
PSYCHOLOGY
Subjects
Details
- Language :
- English
- ISSN :
- 13696513
- Volume :
- 14
- Issue :
- 2
- Database :
- Complementary Index
- Journal :
- Health Expectations
- Publication Type :
- Academic Journal
- Accession number :
- 60676183
- Full Text :
- https://doi.org/10.1111/j.1369-7625.2010.00630.x