Doctoral Dissertation Research: The Co-Construction of End-Of-Life Care

考虑到误解甚至误导护理的可能性，有必要对绝症患者、他们的家人和他们的医生如何相互讨论和计划死亡进行更多的研究。本项目探讨在肺癌晚期患者、他们的肿瘤学家和家庭成员（照护者）的临床访问中讨论（或避免）死亡和临终的方式。该研究使用人种学观察，对记录的谈话和访谈进行分析，在患者病史的背景下，了解如何组织和协商关于死亡的明确讨论。这项研究的发现对任何关心临终关怀的人都很有用，包括医疗决策者、医院、医疗专业人员、家庭和患者。本研究考察了门诊访问是如何互动的，特别是如何做出治疗决定，以及参与者（肿瘤学家、癌症患者和癌症患者护理人员）如何明确地讨论生命结束和死亡问题。研究采用多种方法进行，特别是在癌症诊所进行了两年的参与者观察，对这些观察期间的医生-患者-护理人员对话进行了对话分析，并对肿瘤学家，患者和护理人员进行了半结构化访谈。研究和结果将涉及死亡和临终理论，以及新技术和治疗时代的医患关系，并强调以患者为中心的护理。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Given the potential for misunderstanding and even for misguided care, there is a need for more research on how terminally ill patients, their family members, and their doctors mutually discuss and plan for death. This project examines the ways death and dying are discussed (or avoided) in clinical visits among terminally-ill lung cancer patients, their oncologists, and family members (caregivers). The study uses ethnographic observation, analysis of recorded conversations, and interviews, in the context of the illness histories of patients to make sense of how explicit discussions of death are structured and negotiated. Findings from this study will be useful for anyone concerned with end-of-life care, including medical policymakers, hospitals, medical professionals, families, and patients.This study examines how clinic visits are interactionally structured, in particular, how treatment decisions are made, and how participants (oncologists, cancer patients, and cancer patient caregivers) explicitly discuss end-of-life issues and death. Research is conducted using multiple methods, specifically, two years participant observation at a cancer clinic, conversation analysis of the physician-patient-caregiver conversations during these observations, and semi-structured interviews with oncologists, patients and caregivers. The research and results will engage theories of death and dying and of doctor-patient relationships in an era of new technologies and therapies and emphasis on patient-centered care.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.