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Transience - revising transitions towards end-of-life. Philip J Larkin Health Research Fellow ( Palliative Care), National University of Ireland, Galway Sponsored by the Health Research Board of Ireland and The Irish Hospice Foundation. Outline of the Presentation.

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transience revising transitions towards end of life

Transience - revising transitions towards end-of-life.

Philip J Larkin

Health Research Fellow ( Palliative Care),

National University of Ireland, Galway

Sponsored by the Health Research Board of Ireland and The Irish Hospice Foundation.

outline of the presentation
Outline of the Presentation.
  • Background to the original study.
  • Transition as a description of patient experience.
  • Transition or Transience? Case Exemplars
  • Transience as a concept in palliative care.
  • Conclusions and Implications for practice
slide3

Aim of the Study.

  • To describe advanced cancer patients experiences of the transition between palliative and terminal care.
  • To categorize supportive and limiting factors they experience during transition.
  • To describe the impact of this transition on patients expression of their end of life – palliative/terminal phase.
the study
The Study
  • Qualitative study, phenomenological framework.
  • 6 EU countries ( U.K., Ireland, Spain, Italy, The Netherlands, Switzerland).
  • Interview ( N = 104).
  • Analysis using ATLAS.TI programme.
slide5

Continuity of Care.

B

D

Curative

E

Curative Intent

R

care

E

E

A

A

V

E

M

T

Palliative Care

E

N

H

T

Disease Progression

slide6

Curative Care

Palliative Care

Palliative/terminal care

Specific Oncology treatment

Terminal Phase

Bereavement

Supportive Oncology treatment

Diagnosis

Development

Death

Transition in palliative care.

criteria
Criteria.
  • Advanced cancer diagnosis with prognosis of less than 6 months
  • Able to consent verbally and in writing ( No cognitive impairment)
  • Aware of diagnosis and prognosis
  • Ethical approval granted in each country through local systems
  • Psychological supports.
findings
Findings
  • Van Manen’s (1990) framework of “ Lifeworld Existentials” to coalesce findings:
  • Lived Body
  • Lived Space
  • Lived Time
  • Lived Other
slide10

Lived Body

Shifting complexity of disease

Admission due to altered mind-body function

Emotional response to transition

Seeking Stability

through safety &

security

slide11

Lived Space

Goegraphical Space

Secure Space

Dwelling Space

Challenge to impermanence

slide12

Lived Time

Timing between referral and transition

Rationalising proximity to death

Negotiating within

the shadow of Death

slide13

Lived Other

Meaningful people to the transition process

Changin dynamics of relationship at end of life

Bonds formed with other patients at end-of-life

Shifting bonds

on reflection
On reflection…
  • Does transition as currently described in the literature fit the experiences of this group of palliative care patients?

Impermanence

Stability

Negotiation

Shift

case 1 elizabeth
Case 1, Elizabeth
  • 58 year old woman with a primary brain tumour which led to marked incapacity in terms of her self-care. Lived with her partner and his three children for 11 years. Unexpectedly, her partner requested her to leave their home as he was no longer able to care for her and the children. With nowhere else to go, she was admitted to the hospice. She remained their until she died and had no further contact with her partner or the children again.
case 2 barbara
Case 2, Barbara
  • A 49 year old woman with ca colon, Barbara developed her disease when caring for her husband who subsequently died. She decided to move to live with her married daughter 200 km from her own home. The family home and many of her possessions were sold. Relationships deteriorated and she was admitted to the hospice. She deeply regretted the sale of her home and only wanted to join her husband.
transience
Transience
  • Transience is defined as “the action or fact of passing away” reflecting a lack of permanence, something of limited durability (Oxford English Dictionary 1989).
transience1
Transience
  • Transience would appear as an attribute or consequence of transition.
  • Transience is often used without any clear definition of its meaning or application in the context of the study reported.
  • Undertook conceptual analysis.
transience2
Transience
  • A sudden and unexpected change in life circumstance.
  • Inability to prevent that change
  • A personal shift in both time and space
  • The realisation of a fragile and impermanent existence
  • A sense of stasis
on transience
“ On Transience”
  • “an emotional state where the quality of the present moment may be all the more meaningful because of its fragility and impermanence”.
  • Freud 1916
  • transition as a “phenomenological description of movement” whereas transience refers to an emotional state often associated with sadness and painful feelings
  • Kitayama 1980
attributes
Attributes
  • Fragility & Uncertainty
  • Suddenness of the change
  • Powerlessness in the situation
  • Impermanence of time and space
  • Separation from the construct of home
  • Stasis versus oscillation
at end of life
At end-of-life…
  • It may be that we seek transition because the hope of a positive outcome is easier to deal with than the fragility and impermanence transience offers
  • the shift in clinical emphasis in hospice and palliative care units is suggestive of Augé’s (1995) description of transience as “non-place” – where people simply pass through.
transience3
Transience
  • Transience is a fragile emotional state associated with sadness or painful feelings.
  • Transience can lead to the sudden realisation that nothing is truly permanent.
  • As such, transience emanates particular resonance for palliative care.