A Macmillan Cancer Relief funded study - Liz McDermott

AIMS:
To (systematically) review and analyse palliative care professionals’ written accounts of caring for people with cancer who are knowingly facing death in order to provide another source of knowledge or ‘evidence’ regarding patients’ needs and views, and responses to them.

METHODS:
Systematic review methodology and qualitative research techniques were utilized to locate a range of material written by palliative care professionals in a variety of disciplines across different institutional settings. The search strategy was designed to find published reflective narratives (not original research) in the English language from 1975 onwards, which focused on the experiences of health professionals caring for patients with cancer as they approached their death. The extensive search included electronic databases (e.g. Medline; CINAHL), journals, archives, research networks and the internet. The data analysis was conducted in two stages. Firstly a quantitative analysis was performed and then a qualitative discourse thematic analysis carried out which sought to derive understanding from the narratives through interpretation, rather than aggregation.

RESULTS:
The search strategy yielded 2224 possible articles, books and book chapters. The inclusion/exclusion criteria were then applied independently by two researchers; and 202 pieces of literature met the criteria for inclusion in the review, with physician (34%) and nurse (25%) authors most prominent.

DISCUSSION:
Over the last 30 years, palliative care professionals have been steadily writing about their experiences of caring for people with cancer at end-of life. Representations of the cancer patient and professional practice have shifted from views of the individual as an ‘object’ of medical care, to those of a person who desires autonomy and self-determination. However, preliminary analysis from this study suggests that palliative care professionals’ understanding of patient autonomy is partial, and as a consequence expectations and practice surrounding end-of life care for cancer patients may place limits upon the way in which they face death.