End-of-life conversation from both sides of the bed: voices of family and staff.

PURPOSE: Prolonged living with chronic illness and disability expands the discussion of end-of-life conversation because of the complex role of intercommunication among patient, family, and healthcare staff. Little is known about such interaction from participants' different perspectives. This qualitative case study examined end-of-life conversation among patient, family, and staff during long-term hospitalization in a neurological rehabilitation department. METHODS: After the patient's death, 18 participants responded to in-depth semi-structured interviews: 16 healthcare staff and two family members (the patient's wife and brother). In addition, we used the wife's autoethnographic documentation of her experiences during end-of-life conversation. RESULTS: Thematic analysis produced three themes: (1) The Rehabilitation Department's Mission - Toward Life or Death? (2) The Staff's Perception of the Patient; (3) Containing Death: End-of-life Conversation from Both Sides of the Bed. These themes represented participants' different perspectives in the intercommunication in overt and covert dialogues, which changed over time. Death's presence-absence was expressed by movement between clinging to life and anticipating death. CONCLUSION: The study findings emphasize the importance of practitioners' training to accept and openly discuss death as an inseparable part of life-long disability, and the implementation of this stance during end-of-life care via sensitive conversations with patients and their families.IMPLICATIONS FOR REHABILITATIONIt is vital for rehabilitation professionals to be trained to process and accept end-of-life issues as a natural and inseparable part of the life discourse among people with disabilities and their families.Rehabilitation professionals need to acquire tools to grasp the spoken and unspoken issues related to life and death, and to communicate their impressions and understandings with people with disabilities and their families.Rehabilitation professionals need to encourage an open dialogue when communicating with people with disabilities and their families on processes related to parting and death.

The structure of dyadic support among couples with and without long-term disability.

This study examines support relationships among 65 couples in which the husband had a long-term spinal cord injury, and a comparison group of 65 couples without disability. Based on facet theory, we constructed a mapping sentence that forms a definitional framework for couple support, and developed a detailed inventory to assess attitudes regarding mutual support in couple relations, the sense of support availability, support behaviors of giving and receiving, the degree to which the support meets one's needs, response to received support, and preference for support from within the couple and from external sources. These are all measured with respect to instrumental, emotional and informational support. Smallest space analysis showed various structures of the relations between elements of support among men and women living with and without disability, as well as a core element of reciprocal support common to both men and women in couples with and without disability.

Experiencing Couple Relationships in the Line of Fire.

The study aims to explore the way civilians living in the line of fire experience the impact of exposure to warfare on their couple relationships. Semistructured interviews were conducted with 14 couples living on the Israeli side of the border with the Gaza Strip. Four themes emerged: Overall perception of the security situation's impact on the dyadic relationships, dyadic intimacy, role division and decision-making, and Couple's emotional coping: partnership versus separateness. The findings were organized along a continuum between impacted and not-impacted relationships. Couple's position on this continuum was not fixed and could change as a result of to the security situation or marital therapy. The findings were framed in concepts from Dialectic Theory and from the Family Adaptation Models. Implications for couple therapy in these situations were specified.