University of Kent, Kent, UK.
University of Sheffield, Sheffield, UK.
Sociol Health Illn. 2020 Jul;42(6):1277-1295. doi: 10.1111/1467-9566.13095. Epub 2020 May 6.
Delivery of end-of-life care has gained prominence in the UK, driven by a focus upon the importance of patient choice. In practice choice is influenced by several factors, including the guidance and conduct of healthcare professionals, their different understandings of what constitutes 'a good death', and contested ideas of who is best placed to deliver this. We argue that the attempt to elicit and respond to patient choice is shaped in practice by a struggle between distinct 'institutional logics'. Drawing on qualitative data from a two-part study, we examine the tensions between different professional and organisational logics in the delivery of end-of-life care. Three broad clusters of logics are identified: finance, patient choice and professional authority. We find that the logic of finance shapes the meaning and practice of 'choice', intersecting with the logic of professional authority in order to shape choices that are in the 'best interest' of the patient. Different groups might be able to draw upon alternative forms of professionalism, and through these enact different versions of choice. However, this can resemble a struggle for ownership of patients at the end of life, and therefore, reinforce a conventional script of professional authority.
在英国，临终关怀的提供得到了重视，这是由对患者选择重要性的关注所驱动的。在实践中，选择受到多种因素的影响，包括医疗保健专业人员的指导和行为、他们对什么构成“善终”的不同理解，以及对于谁最适合提供这种关怀的有争议的观念。我们认为，试图引出和回应患者选择的做法在实践中受到不同“制度逻辑”之间斗争的影响。我们借鉴了一项由两部分组成的研究中的定性数据，研究了在提供临终关怀服务时不同专业和组织逻辑之间的紧张关系。确定了三个广泛的逻辑集群：财务、患者选择和专业权威。我们发现，财务逻辑塑造了“选择”的意义和实践，与专业权威逻辑交叉，以塑造符合“患者最佳利益”的选择。不同的群体可能能够利用替代形式的专业精神，并通过这些形式来实施不同版本的选择。然而，这可能类似于对临终患者所有权的争夺，因此，强化了专业权威的传统脚本。
