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

考虑到存在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。这个项目调查了晚期肺癌患者、他们的肿瘤学家和家属(照顾者)在临床就诊中讨论(或避免)死亡和死亡的方式。这项研究使用人种学观察、对录音对话的分析和采访，并结合患者的病史来理解关于死亡的明确讨论是如何组织和谈判的。这项研究的结果将有助于任何关心临终关怀的人，包括医疗政策制定者、医院、医疗专业人员、家庭和患者。这项研究考察了门诊是如何互动组织的，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)如何明确地讨论临终问题和死亡。研究使用了多种方法，特别是在癌症诊所进行了两年的参与者观察，对观察期间医生-患者-照顾者的对话进行了对话分析，以及对肿瘤学家、患者和照顾者的半结构化访谈。这项研究和结果将涉及死亡和死亡理论以及新技术和治疗方法时代的医患关系，并强调以患者为中心的护理。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势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.