'It's hard not to feel like somehow I fell short': A discourse analysis of palliative care providers' experiences with patients' nonphysical suffering.

Abstract

Background: The relief of patients' suffering is central to the philosophy and practice of palliative care. Few studies have focused on interdisciplinary palliative care providers' experiences in addressing patients' nonphysical suffering-suffering that is emotional, psychological, social, spiritual, and/or existential in nature. This study contributes to and expands the empirical knowledge base in this area.

Objective: To identify existing discourses within how palliative care providers talk about their experiences working with patients' nonphysical suffering, and how these discourses may affect palliative care providers and impact clinical care.

Design: This study's methodological approach was informed by discourse analysis, grounded in a poststructural theoretical framework. Discourse analysis guided by poststructural theory highlights that: discourses are constructed; discourses are imbued with tensions and/or contradictions; and discourses do things-they have effects.

Methods: Twenty-four interdisciplinary palliative care providers across Canada participated in semi-structured phone interviews in 2020. Eligible participants had a minimum of 2 years' experience providing palliative care to adult patients in diverse settings, and self-identified as having experience working with patients' nonphysical suffering.

Results: Two competing discourses shape providers' work with patients' nonphysical suffering: (1) 'Expectations of palliative care to relieve nonphysical suffering' and (2) 'Barriers to nonphysical suffering's relief'. The expectation that palliative care will relieve patients' nonphysical suffering emanates from patients and families, from medical teams outside of palliative care, and from providers themselves. Multiple barriers to nonphysical suffering's relief exist at the patient, provider, and systems levels. Providers may experience helplessness, and inadequacy, and can avoid patients' nonphysical suffering when they feel unable to relieve it.

Conclusion: Palliative care has long ascribed nonphysical suffering's relief to the ability of a patient to transcend their own suffering, or a palliative care provider to facilitate/support that transcendence. Findings call into question and expand this long-standing discourse by pushing the field to consider how multiple intersecting barriers at patient, provider, and systems levels shape-and limit-palliative care's call for the relief of nonphysical suffering. Findings have implications for patient care, and interdisciplinary palliative care training, education, and research.