How do healthcare practitioners talk about end-of-life conversations? A poetic inquiry

Abstract

Despite agreement that end-of-life conversations should happen early on in the illness trajectory, it is widely acknowledged that healthcare practitioners often engage in these conversations when death is imminent or avoid the conversation altogether. Healthcare practitioners’ feelings of distress influence how end-of-life conversations are approached, yet thorough exploration of this emotional experience and its impact are largely missing from the literature. The aims of this preliminary scoping literature review using poetic inquiry were to examine physicians’ and nurses’ emotional distress in their accounts of how they approach end-of-life conversations, and to map key concepts relevant to exploring barriers to these conversations. The poetic findings highlight the differing nature of distress for physicians and nurses. Physicians’ distress appears to stem from adhering to their role of ‘curer’ when communicating with terminally ill adult patients at the end of life, whereas the sources of nurses’ distress appear to be interprofessional hierarchies and conflicts. Future research and training that uses methods to decentre and disrupt hierarchies and ingrained practices will be important to nursing practice and in improving end-of-life conversations. Arts-based approaches are one such method that could be pursued.