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

鉴于可能存在误解甚至误导性护理，因此需要对绝症患者、其家人和医生如何相互讨论和计划死亡进行更多研究。 该项目研究了晚期肺癌患者、他们的肿瘤科医生和家庭成员（护理人员）在临床就诊中讨论（或避免）死亡和临终的方式。 该研究利用人种学观察、对话录音分析和访谈，以患者的病史为背景，以了解如何构建和协商有关死亡的明确讨论。 这项研究的结果对任何关心临终关怀的人都有用，包括医疗政策制定者、医院、医疗专业人员、家庭和患者。这项研究探讨了门诊就诊是如何相互作用的，特别是如何制定治疗决策，以及参与者（肿瘤学家、癌症患者和癌症患者护理人员）如何明确讨论临终问题和死亡。 研究使用多种方法进行，具体来说，在癌症诊所进行两年的参与者观察、观察期间医生-患者-护理人员对话的对话分析，以及对肿瘤科医生、患者和护理人员的半结构化访谈。 该研究和结果将涉及新技术和疗法时代的死亡和临终以及医患关系理论，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.