Palliative care and social practice · 2026
'It's given us the opportunity': Patient and clinician experiences of serious illness conversations in the NHS acute setting - Results from a UK Qualitative Study.
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McGlinchey Tamsin, Mason Stephen, Robinson Jude, Ellershaw John Edward
Аннотация
BACKGROUND: Despite legal and ethical commitments to dignified end-of-life care, open communication with seriously ill patients remains inconsistent across the National Health Service (NHS). The Serious Illness Care Programme was implemented in two NHS hospital sites to improve communication and care planning for patients with serious illness.
AIM: Explore the lived experiences of seriously ill patients and their clinicians participating in Serious Illness Conversations.
DESIGN: Qualitative study using a phenomenological approach within an interpretive paradigm. Narrative interviews were undertaken, and Reflexive Thematic Analysis was used to identify patterns of meaning.
SETTING/PARTICIPANTS: Outpatient clinics in two NHS hospital sites: a tertiary cancer centre and a renal unit within a city teaching hospital. Fourteen patients (seven cancer, seven renal failure) and nine clinicians (six oncologists, three nephrologists) were interviewed.
RESULTS: The following three interrelated themes were generated from the analysis: (1) Patients described the conversations as 'a transformative experience', fostering reflection, practical planning, and reframed hope despite a limited prognosis; (2) Serious Illness Conversations were 'different conversations' from routine consultations, with use of the Serious Illness Conversation Guide enabling deeper, more holistic dialogue; however, they were segregated from routine practice; (3) Systemic and cultural barriers hindered these conversations from becoming embedded, perpetuating inequity of access to these conversations: 'Systems, Structure, Process: Serious Illness Conversations, epistemic injustice and cultural violence'.
CONCLUSION: Findings from this study directly challenge the commonly held belief that these conversations are inherently negative to reveal the transformative power of these important and necessary conversations. They opened up different types of conversations, giving patients agency to direct certain aspects of their life. However, their integration into routine practice is hindered by structural and cultural constraints. Addressing these barriers is essential to ensure all patients have equitable access to these conversations.
AIM: Explore the lived experiences of seriously ill patients and their clinicians participating in Serious Illness Conversations.
DESIGN: Qualitative study using a phenomenological approach within an interpretive paradigm. Narrative interviews were undertaken, and Reflexive Thematic Analysis was used to identify patterns of meaning.
SETTING/PARTICIPANTS: Outpatient clinics in two NHS hospital sites: a tertiary cancer centre and a renal unit within a city teaching hospital. Fourteen patients (seven cancer, seven renal failure) and nine clinicians (six oncologists, three nephrologists) were interviewed.
RESULTS: The following three interrelated themes were generated from the analysis: (1) Patients described the conversations as 'a transformative experience', fostering reflection, practical planning, and reframed hope despite a limited prognosis; (2) Serious Illness Conversations were 'different conversations' from routine consultations, with use of the Serious Illness Conversation Guide enabling deeper, more holistic dialogue; however, they were segregated from routine practice; (3) Systemic and cultural barriers hindered these conversations from becoming embedded, perpetuating inequity of access to these conversations: 'Systems, Structure, Process: Serious Illness Conversations, epistemic injustice and cultural violence'.
CONCLUSION: Findings from this study directly challenge the commonly held belief that these conversations are inherently negative to reveal the transformative power of these important and necessary conversations. They opened up different types of conversations, giving patients agency to direct certain aspects of their life. However, their integration into routine practice is hindered by structural and cultural constraints. Addressing these barriers is essential to ensure all patients have equitable access to these conversations.