Karemah François1, Elizabeth Lobb2, Sarah Barclay3, Liz Forbat4. 1. Calvary Centre for Palliative Care Research, Calvary Health Care ACT, Canberra, Australia; School of Health Sciences, Australian Catholic University, Canberra, Australia. Electronic address: karemah.francois@acu.edu.au. 2. Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, Australia; School of Medicine, Univeristy of Notre Dame, Darlinghurst, Australia. Electronic address: Liz.Lobb@health.nsw.gov.au. 3. Medical Mediation Foundation, London, United Kingdom. Electronic address: sarah.barclay@medicalmediation.org.uk. 4. Calvary Centre for Palliative Care Research, Calvary Health Care ACT, Canberra, Australia; School of Health Sciences, Australian Catholic University, Canberra, Australia. Electronic address: elizabeth.forbat@acu.edu.au.
Abstract
OBJECTIVES: Conflict is a significant and recurring problem in healthcare. This study aimed to understand staff and relatives' perspectives on the characteristics of conflict and serious disagreement in adult palliative care, including triggers, risk factors and the impact on themselves and clinical care. METHODS: Qualitative study of 25 staff and seven bereaved relatives using individual interviews, recruited from a multidisciplinary specialist palliative care setting in Australia. Data were analysed thematically. RESULTS: Communication was frequently cited as a cause of conflict. Further, different understandings regarding disease process, syringe drivers and providing nutrition/hydration caused conflict. Staff applied empathy to moderate their responses to conflict. Relatives' reactions to conflict followed a trend of anger/frustration followed by explanations or justifications of the conflict. Relatives identified systemic rather than interpersonal issues as triggering conflict. CONCLUSIONS: The data illustrate connections with conflict literature in other clinical areas, but also points of convergence such as the compassion shown by both families and staff, and the identification of systemic rather than always individual causes. PRACTICE IMPLICATIONS: Family meetings may fruitfully be applied to prevent and de-escalate conflict. Clinical audits may be useful to identify and provide support to families where there may be unresolved conflict impacting grief process.
OBJECTIVES: Conflict is a significant and recurring problem in healthcare. This study aimed to understand staff and relatives' perspectives on the characteristics of conflict and serious disagreement in adult palliative care, including triggers, risk factors and the impact on themselves and clinical care. METHODS: Qualitative study of 25 staff and seven bereaved relatives using individual interviews, recruited from a multidisciplinary specialist palliative care setting in Australia. Data were analysed thematically. RESULTS: Communication was frequently cited as a cause of conflict. Further, different understandings regarding disease process, syringe drivers and providing nutrition/hydration caused conflict. Staff applied empathy to moderate their responses to conflict. Relatives' reactions to conflict followed a trend of anger/frustration followed by explanations or justifications of the conflict. Relatives identified systemic rather than interpersonal issues as triggering conflict. CONCLUSIONS: The data illustrate connections with conflict literature in other clinical areas, but also points of convergence such as the compassion shown by both families and staff, and the identification of systemic rather than always individual causes. PRACTICE IMPLICATIONS: Family meetings may fruitfully be applied to prevent and de-escalate conflict. Clinical audits may be useful to identify and provide support to families where there may be unresolved conflict impacting grief process.