The Dialectics of Care: Communicative Choices at the End of Life

Abstract

Communication at the end of life poses important challenges for patients, families, and caregivers. Previous research on end-of-life communication has concentrated on areas including the provision of bad news and clinical and personal decision making. In this study, we turn our attention to the processes through which caregivers provide comfort in palliative care. Our ethnographic and interview study of spiritual communication among hospice workers and their patients is guided by a dialectical framework. We find a central dialectic in which hospice workers recognize the tension between “leading” and “following” patients and families in discussions of spirituality at the end of life. Our analysis reveals that though some care providers choose one pole of this dialectic, most workers try to manage the dialectic by shifting between leading and following in different situations or different points in time or by transcending the dialectic and addressing the multiple goals of interaction.

Notes

¹This research is part of a larger study on organizational spirituality, communication, and care in hospice settings. This paper highlights issues of care provision in interaction with patients and families. All procedures were approved by the university's Institutional Review Board.

²To protect anonymity, pseudonyms are used for the organization and all participants.