Advance Care Planning: Re-visioning Our Ethical Approach
Planification préalable des soins : la révision de notre approche éthique

Author: Robinson, Carole A.

Source: CJNR (Canadian Journal of Nursing Research), Volume 43, Number 2, June 2011 , pp. 18-37(20)

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Abstract:

This qualitative study explored the applicability and usefulness of a promising advance care planning (ACP) intervention and examined the ACP process. Nine dyads (patients newly diagnosed with advanced lung cancer and a family member) participated in the ACP intervention, with evaluative interviews at 3 and 6 months after the intervention. All interviews were recorded, transcribed verbatim, and analyzed using constant comparison. The process was found not to be one of preparing a substitute decision-maker to speak for oneself and direct health care at a time when one is incapacitated; rather, the families engaged in a deeply relational process where meaning, values, and preferences were negotiated in conversation. ACP is theoretically rooted in a traditional notion of patient autonomy that is not aligned with the relational process that unfolded in this study. An approach that embraces relational autonomy is more congruent and provides a stronger foundation for meeting the needs of families.

French
Cette étude qualitative a exploré l'applicabilité et l'utilité d'une intervention de planification préalable des soins (PPS), et examiné le processus de PPS. Neuf dyades (des patients et patientes auxquels on a diagnostiqué récemment un cancer du poumon à un stade avancé et un membre de leur famille) ont participé à l'intervention de PPS, ainsi qu'à des entrevues évaluatives effectuées trois mois et six mois après l'intervention. Toutes les entrevues ont été enregistrées, transcrites mot à mot et analysées à l'aide de la méthode de la comparaison constante. Il a été constaté que le processus ne préparait pas un mandataire spécial à parler en son propre nom ni à orienter les soins de santé dans la situation où une personne est incapable; il engageait plutôt les familles dans un proces sus relationnel très profond permettant de discuter de la signification, des valeurs et des préférences. En théorie, la PPS repose sur la notion traditionnelle de l'autonomie du patient ou de la patiente, laquelle n'est pas en harmonie avec le processus relationnel qui s'est manifesté dans cette étude. Une approche qui épouse l'autonomie relationnelle est plus congruente et fournit une base plus solide pour répondre aux besoins des familles.

Keywords: ADVANCE CARE PLANNING; ETHICS; PATIENT AUTONOMY; RELATIONAL AUTONOMY

Document Type: Research article

Publication date: 2011-06-01

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CJNR is a peer-reviewed, quarterly journal published by the McGill University School of Nursing since 1969. With world-wide circulation, CJNR's primary mandate is to publish original nursing research that develops basic knowledge for the discipline and examines the application of the knowledge in practice. Research related to education and history is also welcomed, as are methodological, theoretical, and review papers that advance nursing science. Letters or commentaries about published articles are encouraged. Learn more.
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