Organizing end of life in hospital palliative care: a Canadian example

Krawczyk, M. (2021) Organizing end of life in hospital palliative care: a Canadian example. Social Science and Medicine, 291, 112493. (doi: 10.1016/j.socscimed.2019.112493) (PMID:31495608)

Abstract

Hospitals remain the most common location of death in a significant number of countries, and specialist palliative care is positioned as a crucial resource for improving hospital care for those nearing end of life. Little is known, however, about a substantive aspect of this work: how hospital palliative clinicians anticipate and organize a patient's dying trajectory. In this paper I draw from a larger original ethnographic research study of palliative specialists in two Canadian hospitals. Abductive analysis resulted in framing their work as affective labour, both reflecting and re-creating a larger affective economy shaping the affective states of everyone involved in the provision and uptake of care. I articulate six analytically ideal outcomes of clinicians' affective labour that organize end of life, including: 1) proactive co-authorship of disease trajectory; 2) mutual acknowledgement of a dying trajectory; 3) naturalizing direction and outcome of care, 4) ensuring a minimum of social disruption, 5) identification as compassionate and efficient care providers, and 6) increased specialist knowledge and interventions. In so doing, clinicians' practices become understandable as labour to meet a diversity of – at times conflicting – individual, societal, and organizational mandates that necessarily include, but extend well beyond, the patient and her immediate social network. This is the first study to consider hospital palliative care as an affective economy, and presents a theoretically innovative and empirically grounded model to advance new ways of conceptualizing hospital palliative care. I conclude by considering how this model, and the unique insights it affords, can inform the future development of end of life care in hospital settings.

• Item Type: Articles
• Additional Information: The author would like to thank The Michael Smith Foundation for Health Research for a Research Trainee grant that funded part of this research.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Krawczyk, Dr Marian
• Authors: Krawczyk, M.
• College/School: College of Social Sciences > School of Social & Environmental Sustainability
• Journal Name: Social Science and Medicine
• Publisher: Elsevier
• ISSN: 0277-9536
• ISSN (Online): 1873-5347
• Published Online: 16 August 2019
• Copyright Holders: Copyright © 2019 Elsevier Ltd.
• First Published: First published in Social Science and Medicine 291: 112493
• Publisher Policy: Reproduced in accordance with the publisher copyright policy