End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital
Abstract Background Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiol...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | BMC Palliative Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12904-018-0366-5 |
| _version_ | 1819051497326903296 |
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| author | Fiona Ecarnot Nicolas Meunier-Beillard Marie-France Seronde Romain Chopard François Schiele Jean-Pierre Quenot Nicolas Meneveau |
| author_facet | Fiona Ecarnot Nicolas Meunier-Beillard Marie-France Seronde Romain Chopard François Schiele Jean-Pierre Quenot Nicolas Meneveau |
| author_sort | Fiona Ecarnot |
| collection | DOAJ |
| description | Abstract Background Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. Methods We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses’ aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienced end-of-life situations. Interviews were recorded, transcribed and coded using thematic analysis to identify major and secondary themes. Results All physicians (N = 16)(average age 43.5 ± 13 years), 16 nurses (average age 38.5 ± 7.6 years) and 5 nurses’ aides (average age 49 ± 7.8 years) participated. Interviews were held between 30 March and 17 July 2017. The main themes to emerge from the physicians’ discourse were the concept of cardiology being a very active discipline, and a very curative frame of mind was prevalent. Communication (with paramedical staff, patients and families) was deemed to be important. Advance directives were thought to be rare, and not especially useful. Nurses also reported communication as a major issue, but their form of communication is bounded by several factors (physicians’ prior discourse, legislation). They commonly engage in reconciling: between the approach (curative or palliative) and the reality of the treatment prescribed; performing curative interventions in patients they deem to be dying cases causes them distress. The emergency context prevents nurses from taking the time necessary to engage in end-of-life discussions. They engage in comfort-giving behaviors to maximize patient comfort. Conclusion Current perceptions and practices vis-à-vis end-of-life situations in our department are individual, heterogeneous and not yet aligned with recommendations of professional societies. |
| first_indexed | 2024-12-21T12:04:53Z |
| format | Article |
| id | doaj.art-713bb91833c145cbaa7630ecf9d6818a |
| institution | Directory Open Access Journal |
| issn | 1472-684X |
| language | English |
| last_indexed | 2024-12-21T12:04:53Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Palliative Care |
| spelling | doaj.art-713bb91833c145cbaa7630ecf9d6818a2022-12-21T19:04:43ZengBMCBMC Palliative Care1472-684X2018-10-0117111110.1186/s12904-018-0366-5End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospitalFiona Ecarnot0Nicolas Meunier-Beillard1Marie-France Seronde2Romain Chopard3François Schiele4Jean-Pierre Quenot5Nicolas Meneveau6Department of Cardiology, University Hospital Jean MinjozDepartment of Intensive Care, François-Mitterrand University HospitalDepartment of Cardiology, University Hospital Jean MinjozDepartment of Cardiology, University Hospital Jean MinjozDepartment of Cardiology, University Hospital Jean MinjozDepartment of Intensive Care, François-Mitterrand University HospitalDepartment of Cardiology, University Hospital Jean MinjozAbstract Background Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. Methods We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France. Physicians, nurses and nurses’ aides working full-time in the department at the time of the study were eligible. Participants were asked to describe how they experienced end-of-life situations. Interviews were recorded, transcribed and coded using thematic analysis to identify major and secondary themes. Results All physicians (N = 16)(average age 43.5 ± 13 years), 16 nurses (average age 38.5 ± 7.6 years) and 5 nurses’ aides (average age 49 ± 7.8 years) participated. Interviews were held between 30 March and 17 July 2017. The main themes to emerge from the physicians’ discourse were the concept of cardiology being a very active discipline, and a very curative frame of mind was prevalent. Communication (with paramedical staff, patients and families) was deemed to be important. Advance directives were thought to be rare, and not especially useful. Nurses also reported communication as a major issue, but their form of communication is bounded by several factors (physicians’ prior discourse, legislation). They commonly engage in reconciling: between the approach (curative or palliative) and the reality of the treatment prescribed; performing curative interventions in patients they deem to be dying cases causes them distress. The emergency context prevents nurses from taking the time necessary to engage in end-of-life discussions. They engage in comfort-giving behaviors to maximize patient comfort. Conclusion Current perceptions and practices vis-à-vis end-of-life situations in our department are individual, heterogeneous and not yet aligned with recommendations of professional societies.http://link.springer.com/article/10.1186/s12904-018-0366-5End-of-lifeCardiologyPalliative careHeart failure |
| spellingShingle | Fiona Ecarnot Nicolas Meunier-Beillard Marie-France Seronde Romain Chopard François Schiele Jean-Pierre Quenot Nicolas Meneveau End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital BMC Palliative Care End-of-life Cardiology Palliative care Heart failure |
| title | End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital |
| title_full | End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital |
| title_fullStr | End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital |
| title_full_unstemmed | End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital |
| title_short | End-of-life situations in cardiology: a qualitative study of physicians' and nurses’ experience in a large university hospital |
| title_sort | end of life situations in cardiology a qualitative study of physicians and nurses experience in a large university hospital |
| topic | End-of-life Cardiology Palliative care Heart failure |
| url | http://link.springer.com/article/10.1186/s12904-018-0366-5 |
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