Multiple Professional Visions and Inter-Professional Communication at the End-Of-Life: Challenges for Swiss Doctors

Chiara Piccini, Antonella Carassa,Vanessa Alvarado, Brigitte Liebig

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The Project

• NRP 67: End-Of-Life (SNF, 2011-2017)

• Project: Decision-Making in General Practice Settings at the End of Life (2012-2014)

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Research Questions

What is the role of inter-professional communication in end-of-life decision making?

Which are the main challenges?

Which are the possible strategies to face the perceived challenges?

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Theoretical Framing

• Inter-professional collaboration is a qualitative indicator of end-

of-life palliative care (Kauss et al. 1998, Binder/Wartburg 2009)

• Good communication practices as a condition of collaboration

• Inter-relationship between institutional framework (resources

and constraints) and communication practice (Piccini/Carassa/Colombetti 2006)

• Professional visions (Godwin 1994) and communities of practice (Wenger 1998)

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Methods

• Case studies in 3 language regions of Switzerland, Expert

Questionnaires, Expert Interviews

• Group discussions: 91 Family Doctors (FDs), 72 nurses, and 21

relatives

• Qualitative analysis of data, Grounded Theory (Glaser/Strauss,

1974)

• Perspectives of FDs, nurses, and relatives have been triangulated

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Overview of Results

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Findings

• Relevant information to make decisions appears to be fragmented

• Fragmented information challenges the quality of care at the end-of-life

loss of decision making quality unreasonable aggressive treatments and painful death

• Spontaneous non-institutional communicative strategies prevent fragmentation of information

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Discussion

• Communication practices rely on interpersonal relationship and the

strategies are not elaborated enough with respect to defined

processes

This is critical in a globalized multicultural context, characterized also by

frequent professional mobility

• A more flexible retribution system for doctors and arrangements in

hospitals work organization may be useful

Development of collaboration practices and alignment between visions