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Chiara Piccini , Antonella Carassa , Vanessa Alvarado, Brigitte Liebig

Multiple Professional Visions and Inter-Professional Communication at the End-Of-Life: Challenges for Swiss Doctors. Chiara Piccini , Antonella Carassa , Vanessa Alvarado, Brigitte Liebig. The Project. NRP 67: End-Of-Life (SNF, 2011-2017)

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Chiara Piccini , Antonella Carassa , Vanessa Alvarado, Brigitte Liebig

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  1. Multiple Professional Visions and Inter-Professional Communication at the End-Of-Life: Challenges for Swiss Doctors Chiara Piccini, Antonella Carassa, Vanessa Alvarado, Brigitte Liebig

  2. The Project • NRP 67: End-Of-Life (SNF, 2011-2017) • Project: Decision-Making in General Practice Settings at the End of Life (2012-2014)

  3. Research Questions • What is the role of inter-professional communication in end-of-life decision making? • Which are the main challenges? • Which are the possible strategies to face the perceived challenges?

  4. TheoreticalFraming • Inter-professional collaboration is a qualitative indicator of end-of-life palliative care (Kausset al. 1998, Binder/Wartburg 2009) • Good communication practices as a condition of collaboration • Inter-relationship between institutional framework (resources and constraints) and communication practice (Piccini/Carassa/Colombetti 2006) • Professional visions (Godwin 1994) and communities of practice (Wenger 1998)

  5. Methods • Case studies in 3 language regions of Switzerland, Expert Questionnaires, Expert Interviews • Group discussions: 91 Family Doctors (FDs), 72 nurses, and 21 relatives • Qualitative analysis of data, Grounded Theory (Glaser/Strauss, 1974) • Perspectives of FDs, nurses, and relatives have been triangulated

  6. OverviewofResults

  7. Findings • Relevant information to make decisions appears to be fragmented • Fragmented information challenges the quality of care at the end-of-life • loss of decision making quality • unreasonable aggressive treatments and painful death • Spontaneous non-institutional communicative strategies prevent fragmentation of information

  8. Discussion • Communication practices rely on interpersonal relationship and the strategies are not elaborated enough with respect to defined processes • This is critical in a globalized multicultural context, characterized also by frequent professional mobility • A more flexible retribution system for doctors and arrangements in hospitals work organization may be useful • Development of collaboration practices and alignment between visions

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