The Grim Reaper, Hounds of Hell, and Dr. Death: The Role of Storytelling for Palliative Care in Competing Medical Meaning Systems.

Palliative care (PC) is a medical specialty that strives to fulfill the physical, psychosocial, emotional, practical, and spiritual needs of individuals at end of life or in tandem with curative treatment. Although exponentially rising in use and beneficial to patient well-being at end of life, the purpose of PC is often misunderstood and those providing its services frequently report resistance from organizational members. Such resistance can be attributed to tensions between traditional biomedical models of medicine that privilege curative treatment and biosocial models of medicine that holistically care for patients. Thus, this study addresses what tensions PC providers experience in their institutions and what communicative strategies they use at the interpersonal level in managing those tensions. Using structuration theory in tandem with relational dialectics theory, we inductively analyzed semistructured interviews with 24 Circle of Life award-winning PC providers. Findings indicate two dialectics experienced by PC providers in their institutions: the living-dying dialectic and the practicing-advocating dialectic. We conclude that these interpersonal dialectics emerge through interaction in competing medical meaning systems and found that storytelling was a particularly salient form of communication that participants used for management.