Competing Discourses Surrounding Primary Caregivers of Hospice Patients

Abstract

This study helps facilitate health care chaplains' awareness of end-of-life communication experienced by primary caregivers. Relational dialectical theory was used to examine the discourse of twenty primary caregivers of hospice patients. The research questions guiding the study were: what competing discourses do primary caregivers experience during end-of-life care, and how do primary caregivers communicatively manage competing end-of-life discourse? In-depth interviews revealed five major competing discourses which were connected physiologically to the patient's dying trajectories: care versus cure; prolong-life versus end-life; open versus hidden; theodicy; and move-on versus don't-move-on discourse. The primary caregivers negotiated these competing discourses through educating the family, by the use of black humor, spiritualizing, ignoring opposing views, and regulating conversations. Theoretical and practical implications for interventions during end-of-life communication are discussed that may help the Chaplain and families of patients negotiate issues such as signing DNRs, impromptu visits to the hospital, and family conflicts about treatments.

KEYWORDS:

• discourse
• end-of-life communication
• hospice
• primary caregiver
• relational dialectical theory

Notes

Note. DNR = Do not resuscitate. CHF = Congestive heart failure. COPD = Chronic obstructive pulmonary disease.