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A MISMATCH OF EXPECTATIONS? POWER, HIERARCHY AND THE INTERACTION BETWEEN CLINICAL STAFF AND THE OLDER PERSON APPROACHING END-OF-LIFE AND THEIR OLDER LOVED ONES / Christine, Dobbs
BMJ Supportive & Palliative Care, Volume: 3, Issue: 1
Swansea University Author: Christine, Dobbs
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This paper presents findings from a part of a larger qualitative study involving 1) older people, 2) clinical staff, 3) multi-faith spiritual mentors and 4) policy-makers/-influencers in Wales (N=56). Taking a whole-systems approach throughout, a major aim was to identify and rank the expectations t...
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This paper presents findings from a part of a larger qualitative study involving 1) older people, 2) clinical staff, 3) multi-faith spiritual mentors and 4) policy-makers/-influencers in Wales (N=56). Taking a whole-systems approach throughout, a major aim was to identify and rank the expectations that older people in Wales have of high-quality end-of-life care in the hospital setting. Phase 1 comprised in-depth interviews with participant groups 1-3. Phase 2 involved consultation workshops with older people (Nominal Group Technique). Phase 3 saw policy-makers/influencers in Summative Consultation Workshops develop road-maps for change. Demonstrating a bias in the health-care system, health policies and/or procedures are not always culturally sensitive, particularly where the actual needs and preferences are culturally/faith defined. Further – and surprisingly to us – the hospital hierarchy plays an immense role for the older patient and the older carer. A minority experienced excessive frustration through disempowerment when striving to obtain optimal care. Many would not seek to have their needs met due to fear of repercussions. Importantly, for the majority, there appeared to be a conflict in wanting to comply to the system as best they could, but were unsure of what the modern NHS expects from the patient. We question the way in which the NHS understanding of ‘patient-centred care’ and ‘patient choice’ is put into practice. Whilst hierarchy and (mis-)use of power between and within clinical staff groups is a deep-rooted cultural issue, we conclude that the older person approaching end-of-life and their loved ones have, in many cases, different expectations to clinical staff. The patient is tasked with meeting NHS needs, rather than the NHS meeting the patient’s needs.
College of Human and Health Sciences