Palliative care: a foreign language? Nurses' perspectives on palliative care in a French comprehensive cancer centre.

Abstract

Background: Integrated patient-centred palliative care for cancer patients is widely advocated internationally, but promoting it often proves difficult. The literature suggests that one key factor is physicians' perspectives of palliative care (PC). Nurses' views, however, from their pivotal stance within the healthcare team between patients and physicians, have been less well researched. This study explores French nurses' perspectives on PC, how their view frames their role, and how they experience PC implementation. Nurses' discourse is then explored as a reflection of their experience.

Methods: Semi-structured interviews were audio-recorded of 21 registered nurses, purposively sampled, in a French comprehensive cancer centre. Reflexive thematic analysis was applied by a team including a patients' rights representative (a PC carer and applied linguist), the quality manager, and three PC physicians. Considerations of speech emphasis and style completed the analysis.

Results: Analysis generated three themes. Nurses perceive PC as a complex and continuous journey, passing through phases to the end of life. It revolves around patients' physical and psychological well-being, timeliness, patient communication and empowerment. This perception frames their caring role as members of the healthcare team, based on necessary knowledge, training, and working conditions allowing them to fulfil their mission. Consequently, they experience PC implementation as either a virtuous or a vicious circle and suggest ways to improve the latter. Analysis of nurses' discourse enhances the meaningfulness of the thematic analysis, reflecting that the more difficult the care context, the more in-depth the description and the more evaluative and emphatic the words chosen.

Conclusions: These French nurses see their holistic view of PC as diverging from that of physicians, keeping them (painfully) from fulfilling their caregiving role. While the nurses are able to "speak PC" with patients, they see it as a foreign concept/language for physicians (and management), resulting in a sometimes vicious circle of care. Physicians' and management's openness to hearing nurses' views would be a first step towards patient and professional well-being. As the nurses suggest, a palliative approach and communication skills can be learned, and institutions can commit to rethinking priorities, policies, and resources. PC can become a shared language.