[Conflicts between healthcare professionals and families of a multi-ethnic patient population in the intensive care unit]. / Conflict tussen zorgverleners en families van een multi-etnische patiëntenpopulatie op de IC.

OBJECTIVE: To investigate which factors contribute to conflicts between healthcare professionals and family members from ethnic minority groups during medically critical situations in hospital. DESIGN: Descriptive, ethnographic research. METHOD: Ethnographic fieldwork was carried out in one intensive care unit (ICU) of a multi-ethnic urban hospital in Belgium in the period January-June 2014. Data were collected by means of negotiated interactive observation, in-depth interviews with healthcare professionals and examining the patients' medical files. Data were analysed using grounded theory procedures. RESULTS: Conflicts were primarily related to the participants' different views on 'good care'. Healthcare providers' (HCPs') views on good care were primarily grounded on a biomedical care model, whereas families' views on good care were mainly inspired by a holistic care approach. According to HCPs, giving good care included fighting the disease efficiently with great scientific competence, but family members considered this rather as attending to the patient and giving bedside care, amongst other things. The HCPs' biomedical vision on good care was strengthened by the strict application of ward regulations, characterizing the ICU setting. The families' holistic views on good care were strengthened by specific ethno-familial characteristics, including their ethno-cultural background. However, ethno-cultural differences only contributed to conflict if the policy context on the ICU could provoke this conflict. CONCLUSION: Conflicts cannot be exclusively linked to ethno-cultural differences. Structural, functional characteristics of the ICU contribute substantially to conflict development. Effective conflict prevention should, therefore, not only focus on ethno-cultural differences but should also focus sufficiently on the structural context and ward policy.

Changing preferences for information and participation in the last phase of life: a longitudinal study among newly diagnosed advanced lung cancer patients.

PURPOSE: The objective is to explore changes over time in the information and participation preferences of newly diagnosed stage IIIb/IV non-small-cell lung cancer patients. METHODS: Patients were recruited by physicians in 13 hospitals and interviewed every 2 months until the fourth and every 4 months until the sixth interview. RESULTS: Sixty-seven patients were interviewed three times. Over a period of 4 months from diagnosis, half of patients changed their information preferences for palliative care and end-of-life decisions with a possible or certain life-shortening effect (ELDs, e.g., non-treatment decisions) in both directions, from not wanting to wanting the information, but also--and as much--from wanting to no longer wanting it. The latter were more likely to be in a better physical condition. Preferences for participation in medical decision making also changed: 50% to 78%, depending on the type of decision (general, treatment, transfer or ELD), changed their preference towards wanting more or less participation. Pain seemed to be a trigger for patients wanting more involvement, which contrasts with studies suggesting that patients who are more ill tend to give up more control. CONCLUSIONS: Doctors should regularly ask their advanced lung cancer patients how much information and participation they want because preferences do change in unexpected ways.

Information disclosure to terminally ill patients and their relatives: self-reported practice of Belgian clinical specialists and general practitioners.

Objective of this study is to examine physicians' practices regarding information disclosure to terminally ill patients and to their relatives, without informing the patient. A questionnaire had been sent to a random sample of 3014 Belgian physicians from different specialties frequently involved in end-of-life care. Responses were analysed using weighted percentages, Chi-square, Mann-Whitney U-tests and a multivariate ordinal logistic regression. Response rate was 58%. Both clinical specialists and general practitioners (GPs) discuss most topics related to terminal illness with their patients except end-of-life hastening options, spirituality, life expectancy and options to withhold/withdraw life-sustaining treatment. The topics which most physicians always discuss with relatives without informing the patient are the aim of treatment, palliative care and incurability. There is a significant difference between clinical specialists and GPs. Clinical specialists and GPs discuss most end-of-life topics with the patient but omit important issues such as end-of-life hastening options and life-expectancy.