Early Palliative Care Team's Perception of Relational Work for Advanced Cancer Patients: A Qualitative Study.

BACKGROUND

In a day hospital stay, the palliative care (PC) delivery includes multi-disciplinary assessment of palliative care (PC) needs, with treating oncologist and supportive care professionals with a long time allocated for discussions with the patients and family. But little is known about the specificity of the relational work delivered by the PC team.

AIMS: The aim of this study was to explore the nature of the relational work carried out at the PC day hospital from the perspective of the PC team.

METHODS

This qualitative research used semi-structured open-ended interviews, conducted and analysed according to grounded theory. Twelve physicians and twelve nurses from PC team were interviewed over a period of 5 months to collect clinical cases.

RESULTS

The analysis resulted in three main categories that explain the processes of relational work during PC Day Hospital sessions: (1) Patient engagement is necessary to increase relational work and gain patients' confidence. This involves initiating medical exchanges from the patient's point of view to obtain their participation; (2) Raising awareness of irreversible decline and approaching death using interactive relational work tactics, in line with oncologists when making decisions and announcing the discontinuation of cancer treatment; (3) Managing the final phase of the cancer trajectory requires negotiating home care terms and being aware of the family's influence.

CONCLUSIONS

PC day hospital in cancer centres allows a pluri-professional relational work including the oncologists which facilitates serious illness conversation, advance care planning and end-of-life care management for advanced cancer patients.