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Supportive and palliative care – distinct or part of a continuum?. Dr Sue Duke Consultant Practitioner in Cancer and Palliative Care/Senior Lecturer sd11@soton.ac.uk School of Health Sciences. Reframing care (Corner and Dunlop 1997).

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supportive and palliative care distinct or part of a continuum

Supportive and palliative care – distinct or part of a continuum?

Dr Sue Duke

Consultant Practitioner in Cancer and Palliative Care/Senior Lecturer

sd11@soton.ac.uk

School of Health Sciences

reframing care corner and dunlop 1997
Reframing care (Corner and Dunlop 1997)

Scrutiny of construction of care (political, social, cultural, physical, emotional)

Evaluate impact

Deconstruct problem, issue or situation

Deconstruct power relationships

Reflect on therapeutic processes

Introduce care into environment

Identify therapeutic role and relationships

Reconstruct new approach environment or system

looking for meaning the value placed within understanding
Looking for meaning – the value placed within understanding

What does supportive care and palliative care mean to different people?

What kind of value is placed on each?

What is the power relationship between supportive and palliative care?

How is this relationship influenced by clinical setting/culture?

How does this relationship influence care and professional’s understanding of roles?

meaning can indicate marginalisation
Meaning can indicate marginalisation
  • Meanings can marginalise people from appropriate support and symptom management , eg:
    • People not seen as fitting with the meanings of supportive and palliative care eg people with non-malignant illness or people without diagnosis or without metastatic spread or those waiting for diagnosis or who are currently considered to be free from disease
  • Meanings marginalise staff from appropriate support to care for people with support and symptom management needs
meanings can serve to enhance power bases
Meanings can serve to enhance power bases

Meanings can reinforce professional boundaries

Professional boundaries are the place where power is ‘policed’

...and can be a place where personal boundaries are breached

Important to get a balance between appropriate use of resources – the justice of care – and appropriate therapeutic response.

working with meanings
Working with meanings

Thinking about our practice

as travel to differing places

in order to understand the meanings provoking referral

to describe the architecture

beliefs and values

and thinking schemas.

Understanding these cultural characteristics

define the symbolic domain of professional practice

the pre-text, the way in which practitioners

‘read’ and respond to the practice

so that we can respond

to the situation

in a way that takes account of these cultural characteristics

in order to transform the situation

through a participative relationship

Duke S (2007)