Disrupting and expanding the discourse: Palliative care clinicians' experiences with patients' non-physical suffering
Bibliographic record
Abstract
While one of the primary aims of palliative care is to prevent and relieve suffering, both physical and non-physical, research to date has been very limited re: clinicians’ experiences with patients’ non-physical suffering (e.g., suffering that may be psychological, emotional, social, spiritual and/or existential in nature); both how clinicians work with/respond to this kind of suffering in their day-to-day work, and the effect of this aspect of their work on clinicians themselves. No research to date has considered the impact of palliative care’s dominant non-physical suffering discourse — which presents the relief of non-physical suffering as falling along a binary spectrum of suffering’s transcendence via meaning-making on one end of the spectrum, and palliative sedation and/or a medically assisted death on the other end — on how clinicians work with patients’ non-physical suffering. This study aims to help fill these research gaps. Using discourse analysis as the methodology, and poststructuralism as the overarching theoretical framework, this project has several research aims: (1) To identify what discourses exist within palliative care clinicians’ experiences with patients’ non-physical suffering; (2) To identify whether and how these discourses may affect palliative care clinicians and impact clinical care; and (3) To identify whether clinicians’ experiences with patients’ non-physical suffering fall within and/or outside the dominant discourse. Over a three month period in summer/fall 2020, 24 palliative care clinicians (social workers, physicians, nurses, music therapists, and an occupational therapist) from across Canada participated in this study. The majority of study participants identified as white, female, spiritual, practiced full-time in a combination of palliative care practice settings, and had between 10-19 years of palliative care practice experience. Four discourses are visible within how participants talked about their experiences with adult patients’ non-physical suffering: 1) Expectations of Palliative Care; 2) Unexpressed Non-Physical Suffering; 3) Medical Assistance in Dying (MAiD); and 4) The Professional in the Personal/The Personal in the Professional. Study findings demonstrate both the negative effects of the dominant discourse on clinicians and how they work with patients’ non-physical suffering, as well as how clinicians resist the dominant discourse. Findings have implications for palliative care practice, clinician training, education and support, and future research. It is anticipated/hoped that this study’s findings will ultimately help to disrupt and expand palliative care’s non-physical suffering discourse, to make it more inclusive of the on-the-ground realities of clinicians’ experiences navigating non-physical suffering on the front-lines of palliative care provision.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.021 | 0.040 |
| Scholarly communication | 0.013 | 0.013 |
| Open science | 0.002 | 0.018 |
| Research integrity | 0.005 | 0.011 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".