Abstract

Communication about prognosis is integral to effective palliative care. However, prognosis communication often entails considering mortality, which can trigger existential questions. We understand very little about how existential experience is communicated in palliative care conversations. To fill this gap, this dissertation addresses the following aims: (1) Clarify the concept of the existential experience within the context of adults with advanced cancer (Chapter 2); (2) Describe how patients, families, and clinicians communicate about existential experience in palliative care conversations (Chapter 3); and (3) Explore the intersection between prognosis communication and existential dimensions of conversation (Chapter 4). To accomplish Aim 1, we synthesized published qualitative literature regarding how adults with advanced cancer describe their existential experience. Using Rodgers' evolutionary method of concept analysis, we conceptualize existential experience as a dynamic state, preceded by confronting mortality, defined by diverse reactions to shared existential challenges related to parameters of existence (body, time, others, and death), resulting in a dialectical movement between existential suffering and joy. To address Aims 2 and 3, we analyzed a randomly selected subset of an existing Palliative Care Communication Research Initiative (PCCRI) study dataset. PCCRI data includes verbatim transcripts of inpatient palliative care consultations with adults with advanced cancer. Using a qualitative descriptive approach, we found that overall, existential communication was woven within palliative care conversations, and related to key themes of: 1) Time as a pressing boundary; 2) Maintaining a coherent self; and 3) Connecting with others. In Chapter 4, we took a mixed methods approach, quantitatively stratifying the study sample by levels of prognosis communication and qualitatively describing existential dimensions of conversations within and across none, low, and high levels of prognosis communication. We found existential and prognosis communication were deeply interconnected. Additionally, existential communication was more common within conversations with higher levels of prognosis communication, representing an existential shift compared to the more physical focus of conversations with no prognosis communication. This dissertation generates new knowledge about how existentialexperience is communicated during naturally-occurring palliative care conversations. Our findings have implications for improving how we communicate with, and care for, individuals with advanced cancer and their families.

Description

Dr. Tarbi was a recipient of the 2018-2019 Sigma/Hospice and Palliative Nurses Foundation End of Life Nursing Care Research (HPNA) Grant. The report can be found here: http://hdl.handle.net/10755/21444

Elise C. Tarbi

Author Details

Elise C. Tarbi, PhD, MBE, CRNP, ACHPN

Sigma Membership

Xi

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Descriptive/Correlational

Research Approach

Mixed/Multi Method Research

Keywords:

Palliative Care, End-of-Life Coversations, Existential Experience, Prognosis Communication, Adult Patients, Advanced Cancer

Advisors

Meghani, Salimah||Gramling, Robert||Bradway, Christine

Degree

PhD

Degree Grantor

University of Pennsylvania

Degree Year

2020

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2023-10-26

Full Text of Presentation

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