Exploring symptom meaning: perspectives of palliative care physicians

Context Understanding patients’ symptom experiences is essential to providing effective clinical care. The discussion between patients and physicians of symptom meaning and its significance, however, is ill understood. Objectives To investigate palliative care physicians’ understanding of symptom me...

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Bibliographic Details
Published in:Supportive care in cancer 2018-08, Vol.26 (8), p.2769-2784
Main Authors: Estacio, Celina F., Butow, Phyllis N., Lovell, Melanie R., Dong, Skye T., Clayton, Josephine M.
Format: Article
Language:English
Subjects:
Adult
Aged
Analysis
Evidence-based medicine
Female
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Nursing
Nursing Research
Oncology
Original Article
Pain Medicine
Palliative care
Palliative Care - standards
Patients
Physician-patient relations
Physicians
Physicians - standards
Qualitative Research
Rehabilitation Medicine
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Summary:Context Understanding patients’ symptom experiences is essential to providing effective clinical care. The discussion between patients and physicians of symptom meaning and its significance, however, is ill understood. Objectives To investigate palliative care physicians’ understanding of symptom meaning, and their experiences of and attitudes towards the discussion of symptom meaning with patients. Methods Semi-structured interviews were conducted ( N  = 17) across Sydney, Australia. Transcripts were analysed using framework analysis. Results Six key themes were identified: (1) definitions of symptom meaning (causal meanings, functional impact, existential impact, and cascade of meanings); (2) meanings are personal (demographic, culture, spiritual, and family differences); (3) eliciting meanings requires subtlety and trust (following the patient’s cues); discussing meaning can be (4) hard (for the patient and health professional); (5) therapeutic (assuaging fears, feeling listened to and valued, increased sense of control, and reduced symptom distress); and (6) enhances clinicians’ practice and work satisfaction (provision of more tailored care, reassurance through the provision of information, and strengthening of doctor-patient relationship). Conclusions Exploring symptom meaning can serve to provide information, alleviate anxiety, and facilitate individualised care, but only when patients present cues or are open to discuss symptom-related concerns. However, various barriers hinder such dialogue in consultations. Greater awareness of symptom meaning and its influence may facilitate physicians exploring symptom meaning more with patients in the future.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-018-4126-0