Multidisciplinary clinicians and the relational autonomy of persons with neurodegenerative disorders and an Advance Care Plan: a thematic analysis
Craig, Denise Patricia, Ray, Robin, Harvey, Desley, and Shircore, Mandy (2021) Multidisciplinary clinicians and the relational autonomy of persons with neurodegenerative disorders and an Advance Care Plan: a thematic analysis. Journal of Multidisciplinary Healthcare, 14. pp. 3385-3398.
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Abstract
Introduction: People diagnosed with neurodegenerative disorders often grapple with threats to their agency, prompting some to engage in advance care planning. Advance care plans are intended to protect autonomy by helping patients receive goal-consistent healthcare. Accordingly, there is a need to better understand factors associated with hospital doctors' application of advance care plans to treatment decisions of this patient cohort.
Purpose: The purpose of this study was to explain the recommendations of multidisciplinary hospital-based clinicians about the benefits of advance care plans for people diagnosed with neurodegenerative disorders, and the elements that influence how doctors apply such plans. Materials and Methods: Using a constructivist grounded theory informed thematic analysis, semi-structured interviews were conducted with purposively and theoretical sampled hospital-based clinicians: 16 doctors, six registered nurses and 10 allied health clinicians who self-reported having experience delivering healthcare to people with neurodegenerative disorders and an advance care plan. Allied health and nurse data helped to inform questions posed to doctors. Data were inductively analysed using open and focused coding.
Results: Analysis revealed two main themes: recommending agency through advance care plans; and limiting agency through advance care plans. These themes formed the basis of the core category: patient agency. All clinicians held positive attitudes towards advance care plans as a means to preserve patient voices and alleviate family of responsibility. However, the extent to which doctors shared decisions with family revealed a tension between individualistic agency associated with advance care plans and relational autonomy perceived by doctors as appropriate.
Conclusion: Although doctors expressed positive attitudes towards advance care plans, they typically practiced relational autonomy wherein they partner with family in contemporaneous healthcare decision on patients' behalf. Accordingly, the healthcare preferences of hospitalised, incompetent people with neurodegenerative disorders are balanced against judgements of both doctors and family.
| Item ID: | 72128 |
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| Item Type: | Article (Research - C1) |
| ISSN: | 1178-2390 |
| Keywords: | advance directive,allied health,end-of-life,hospital doctors,patient agency,registered nurses,relational autonomy |
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| Copyright Information: | 2021 Craig et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php) |
| Date Deposited: | 09 Feb 2022 08:58 |
| FoR Codes: | 42 HEALTH SCIENCES > 4203 Health services and systems > 420316 Palliative care @ 40% 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 40% 42 HEALTH SCIENCES > 4203 Health services and systems > 420303 Family care @ 20% |
| SEO Codes: | 20 HEALTH > 2003 Provision of health and support services > 200304 Inpatient hospital care @ 70% 20 HEALTH > 2003 Provision of health and support services > 200309 Palliative care @ 30% |
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