Barriers to end-of-life discussions among hematologists: A qualitative study.

BACKGROUND: Integrated palliative care is correlated with earlier end-of-life discussion and improved quality of life. Patients with haematological malignancies are far less likely to receive care from specialist palliative or hospice services compared to other cancers. AIM: The main goal of this study was to determine hematologists' barriers to end-of-life discussions when potentially fatal hematological malignancies recur. DESIGN: Qualitative grounded theory study using individual interviews. SETTING/PARTICIPANTS: Hematologists ( n = 10) from four hematology units were asked about their relationships with their patients and their attitudes toward prognosis and end-of-life discussions at the time of recurrence. RESULTS: As long as there are potential treatments, hematologists fear that end-of-life discussions may undermine their relationship and the patient's trust. Because of their own representations, hematologists have great difficulty opening up to their patients' end-of-life wishes. When prognosis is uncertain, negative outcome, that is, death, is not fully anticipated. Persistent hope silences the threat of death. CONCLUSION: This study reveals some of the barriers clinicians face in initiating early discussion about palliative care or patients' end-of-life care plan. These difficulties may explain why early palliative care is little integrated into the hematology care model.

[Chapter 5. End of life and handicap: what "theology" can bring to the capability approach]. / Chapitre 5. Fin de vie et handicap : quelle contribution possible de « la théologie ¼ à une approche des capacités.

By adressing specifically the issue of handicap at the end of life, I will question theology in the frame of a capability approach. In what sense theology in its analogical sense can find its place in the contemporary approach of capabilization? Can it extend the meaning of capabilities? If it first puts in perspective a relational and contextual web of those who experience a shared experience; I will then argue that it invites to a certain prudence towards the concept of handicap and end of life. The risk of closure, rather than openness to an experience of growth for the subject who is able to confront this experience is to be avoided.

[From using a model of decisional clinical ethics to constituting a place for collective learning. The experience of a reflexive seminar between healthcare professionals and ethics researchers]. / De l'usage d'une grille d'éthique clinique décisionnelle à la constitution d'un lieu d'apprentissage collectif. L'expérience d'un séminaire réflexif entre professionnels de santé et chercheurs en éthique.

This paper shows how an experimental clinical ethics device, proposed by researchers in ethics to intensive care units professionals, has created a collective learning context. The outcome of such a collective learning has been the progressive working-out, from the clinical and care practice, of a given clinical ethics grid into a more intensive care units context adapted grid. Some comments are made about the importance to subjectivize a clinical ethics approach, about the collective learning device installed throughout the joint health care professionals--researchers in ethics seminar and about the need to institutionalize ethics.