Work towards ‘making sense of the situation’
| Description | Examples |
|---|---|
| Focus on getting to know the patient and their personal life story | ‘We know everything medically about them, but we don't know their story and we don't know what informs the decisions they've made to this point and sometimes it can be as simple a thing as they had a really bad illness when they were young, and they got better, therefore they're going to get better this time.’ (Resident physician) |
| Recognising that the patient has a unique interpretation of what is happening, and what a ‘correct’ course of action might be is individual | ‘We're not the patient and although we have our own opinion about what is the best thing to do but regardless that's…you know, the goal should be to try to make the patient make the decision with our help in terms of trying to choose the best thing.’ (Resident physician) |
| Work helping patients and families understand the complex situations they were facing, helping them make sense of responses to treatments, and clarifying messages given by other members of the team. | ‘They've just been told something potentially devastating. So you've got to ask how much they actually retained. So that's usually the best place. So gleaning a bit of an insight into what they understand, what they retain, what this means to them or what they're understanding it means, is probably the biggest step for the nurse to take after they've had that change.’ (Nurse) |
| Experiencing moral distress related to different perspectives about the importance of prognosis or the value of suffering | ‘I went in, and I saw the patient and I literally had tears in my eyes. It's like oh my gosh, I cannot believe that this body still has a soul living in it because it was terrible. And yet I wanted to be very respectful of the decision-maker who I thought had a very valid perspective. So there's that conflict sometimes of perspective. I think I realise people just need time to absorb things.’ (Staff physician) |
| To make a recommendation for care, healthcare professionals also needed to establish meaning. | ‘Sometimes it's denial; sometimes it's that we don't have time or sometimes it's about us, we're not comfortable making that decision either. If we aren't… if I am not sure of the prognosis, if I think they might get better through some intervention, but at the same time there's other factors, like the intervention is pretty invasive, then in those cases [we delay the decision].’ (Resident physician) |