Boström Kathleen, Dojan Thomas, Thölking Thessa, Gehrke Leonie, Rosendahl Carolin, Voltz Raymond, Kremeike Kerstin
Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany.
Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
Palliat Support Care. 2025 Mar 24;23:e83. doi: 10.1017/S1478951524002104.
Up to 40% of seriously ill patients develop a (temporary) desire to die which can lead to requests for assisted dying. Health professionals often feel uncertain about addressing these topics, while informal caregivers may feel guilty and left out. Open and respectful communication proves beneficial. It remains unclear how this communication ideal realizes within the lived experience of all 3 parties. Therefore, we conducted in-depth analysis of communication strategies about desire to die from triangulated perspectives of patients, informal caregivers, and health professionals.
We conducted semi-structured interviews with purposefully sampled triads consisting of seriously ill patients, their respective informal caregivers and health professionals. Interviews were part of the qualitative evaluation of a 3-phase mixed-methods study on the effects of communication about desire to die on seriously ill patients. We followed a framework analysis approach to build communication types.
From the = 13 patients, 54% suffered from oncological diseases. Health professionals ( = 13) were multiprofessional. Informal caregivers ( = 13) were partners, children, or another relation. All in all, we conducted = 14 interview triads ( = 3 incomplete; = 39 individual interviews).Four key themes emerged from analysis: (a) how open communication was perceived, (b) whether participants reported shared reality, (c) how they talked about death, and (d) their communication strategies.Ultimately, 3 communication types were inductively derived at from these key themes. Type 1 "Between the Lines," type 2 "Past each Other" and type 3 "Matter of Fact" show differing expressions on the key themes, especially on (b) shared reality. Specific type characteristics produce suggestions for health professionals' communicative practice.
Awareness of typical communication strategies is necessary to foresee potential pitfalls such as loss of information or acting on unchecked assumptions. To reduce distress and increase information flow, health professionals should actively approach informal caregivers for desire to die conversations.
高达40%的重症患者会产生（暂时的）死亡意愿，这可能导致其提出安乐死请求。医护人员在处理这些话题时常常感到不确定，而非正式照护者可能会感到内疚和被忽视。开放且尊重的沟通被证明是有益的。目前尚不清楚这种沟通理想状态在三方的实际经历中是如何实现的。因此，我们从患者、非正式照护者和医护人员的三角视角对关于死亡意愿的沟通策略进行了深入分析。
我们对由重症患者、其各自的非正式照护者和医护人员组成的有目的抽样三元组进行了半结构化访谈。这些访谈是一项关于死亡意愿沟通对重症患者影响的三阶段混合方法研究的定性评估的一部分。我们采用框架分析方法来构建沟通类型。
在13名患者中，54%患有肿瘤疾病。医护人员（13名）来自多个专业领域。非正式照护者（13名）为伴侣、子女或其他亲属。总体而言，我们进行了14个访谈三元组（3个不完整；39次个人访谈）。分析得出了四个关键主题：（a）对开放沟通的看法，（b）参与者是否报告有共同认知，（c）他们如何谈论死亡，以及（d）他们的沟通策略。最终，从这些关键主题中归纳出了三种沟通类型。类型1“字里行间”、类型2“彼此错过”和类型3“实事求是”在关键主题上表现出不同的表达，尤其是在（b）共同认知方面。特定的类型特征为医护人员的沟通实践提供了建议。
了解典型的沟通策略对于预见潜在陷阱（如信息丢失或基于未经检验的假设行事）很有必要。为了减少痛苦并增加信息流，医护人员应积极与非正式照护者就死亡意愿进行沟通。
