- Title
- Understanding specialist decision-making at end of life in Australia and a comparative account from Viet Nam
- Creator
- Harrington, Chris
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Most people in high income countries die in places they do not choose, with little help to prepare for death, and with undertreatment of pain and other symptoms. Seventeen cardiologists, oncologists and surgeons in New South Wales, Australia, were interviewed to provide a comprehensive overview of what these specialists consider in their decision-making for patients with advanced illness. While primarily a study in Australia, five cardiologists were interviewed in one region of Viet Nam to identify whether similar considerations influence cardiologists’ decision-making in a middle income country with a different cultural, regulatory and structural system. A Donabedian framework of structures, processes and outcomes is employed as a conceptual model to examine their accounts and consider the doctor as both technician and healer. Within Australia, professional specialty, illness type, and the lack of certainty regarding illness trajectory influenced when or if patients are informed of the severity of their illness or referred to palliative care. Fragmentation and the absence of a defined care pathway makes it unclear which specialist needs to go beyond managing the disease to consider broader needs of the patient. Australian specialists identified disconnected care for patients attending public emergency departments for acute exacerbations as risking clinically inappropriate or unsafe interventions, and described the potential over-use of (particularly) cardiology services in private hospitals driven by volume-based accreditation criteria and financial incentives. Most Australian specialists were not present when the patients died, emphasising the role of physician as technician over the role of healer. In contrast, the cardiologists in Viet Nam maintained greater involvement with their patients’ care until death was imminent, were more likely to report pain as a feature of heart failure and never informed patients of impending death, leaving that role to family members. Possible solutions to care that is less than optimal in Australia are described.
- Subject
- end of life; decision-making; specialists; Australia; Vietnam; oncologists; cardiologists
- Identifier
- http://hdl.handle.net/1959.13/1513271
- Identifier
- uon:56705
- Rights
- Copyright 2022 Chris Harrington
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 447 KB | Adobe Acrobat PDF | View Details Download |