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The art of letting go: Referral to palliative care and its discontents

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  • Broom, Alex
  • Kirby, Emma
  • Good, Phillip
  • Wootton, Julia
  • Adams, Jon

Abstract

Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break ‘bad news’ to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process.

Suggested Citation

  • Broom, Alex & Kirby, Emma & Good, Phillip & Wootton, Julia & Adams, Jon, 2013. "The art of letting go: Referral to palliative care and its discontents," Social Science & Medicine, Elsevier, vol. 78(C), pages 9-16.
    • Handle: RePEc:eee:socmed:v:78:y:2013:i:c:p:9-16
    DOI: 10.1016/j.socscimed.2012.11.008
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    References listed on IDEAS

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    1. Walshe, Catherine & Chew-Graham, Carolyn & Todd, Chris & Caress, Ann, 2008. "What influences referrals within community palliative care services? A qualitative case study," Social Science & Medicine, Elsevier, vol. 67(1), pages 137-146, July.
    2. Hibbert, Derek & Hanratty, Barbara & May, Carl & Mair, Frances & Litva, Andrea & Capewell, Simon, 2003. "Negotiating palliative care expertise in the medical world," Social Science & Medicine, Elsevier, vol. 57(2), pages 277-288, July.
    3. Wallace, Jean Elizabeth & Lemaire, Jane, 2007. "On physician well being--You'll get by with a little help from your friends," Social Science & Medicine, Elsevier, vol. 64(12), pages 2565-2577, June.
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    Cited by:

    1. Kirby, Emma & Broom, Alex & MacArtney, John & Lewis, Sophie & Good, Phillip, 2021. "Hopeful dying? The meanings and practice of hope in palliative care family meetings," Social Science & Medicine, Elsevier, vol. 291(C).
    2. Alex Broom & W K Tim Wong & Emma Kirby & David Sibbritt & Deme Karikios & Rosemary Harrup & Zarnie Lwin, 2016. "A Qualitative Study of Medical Oncologists’ Experiences of Their Profession and Workforce Sustainability," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-15, November.
    3. Hauge, Amalie M., 2020. "One last round of chemo? Insights from conversations between oncologists and lung cancer patients about prognosis and treatment decisions," Social Science & Medicine, Elsevier, vol. 266(C).

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