Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

PATIENT EDUCATION AND COUNSELING

卷:100

Article

Shaw, Chloe¹  Chrysikou, Vasiliki²  Davis, Sarah³  Gessler, Sue¹  Rodin, Gary⁴  Lanceley, Anne¹ 

[1] UCL, UCL EGA Inst Womens Hlth, London, England

[2] UCL, Res Dept Primary Care & Populat Hlth, London, England

[3] UCL, Marie Curie Palliat Care Res Dept, Div Psychiat, London, England

[4] Univ Toronto, Univ Hlth Network, Princess Margaret Canc Ctr, Dept Support Care, Toronto, ON, Canada

关键词: Psychotherapy;    CALM;    Cancer;    End-of-life talk;    Death;    Palliative care;    Conversation analysis;   

DOI  :  10.1016/j.pec.2016.08.024

来源: Elsevier

【 摘 要 】

Objective: To examine how end-of-life talk is initiated in CALM therapy sessions with advanced cancer patients. Methods: Conversation analysis was used to systematically examine the sequences where talk about death was raised in the first sessions of ten patients. Results: Open questions about the patients' experiences, feelings or understanding in the context of talk about their troubles, were found to regularly elicit talk concerning end-of-life. These questions were designed in ways that invite patients to discuss troubling aspects of their cancer journey, without making discussion of this topic an interactional requirement. That is, the interactional work required to not engage in such talk is minimised. This choice is provided through the open question design, the degree to which negative feeling descriptors are specified, and the sequential context of the question. Conclusion: The analysis shows that therapists provide patients with the opportunity to talk about endof- life in a way that is supportive of the therapeutic relationship. The readiness of patients to engage in end-of-life talk displays the salience of this topic, as well as the reflective space provided by CALM therapy. Practice implications: The results provide important insight into the process of CALM therapy, which can be used to guide training. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free