An Intercultural Analysis of End-of-Life Consultation Practices in Palliative Medicine in Germany

Abstract

End-of-life discussions are a difficult but important facet both within the daily routines of an individual's life, as well as within the medical sphere. The care of a patient, in regards to the management of their symptoms and livelihood, is different for each patient that the physician oversees. The management of their care through various examinations or regiments is tailored towards the needs of each individual patient. Since its conception in 1972 as a recognized field of medicine, palliative medicine has grown to become a tool that physicians utilize to aid patients suffering from terminal illnesses. "Palliative care is the active, total care of an individual patient's body, mind and spirit, as well as the supporting family members¹." Palliative care begins when the illness is first diagnosed, and continues regardless of whether or not a patient receives treatment directed towards the diagnosed diseases. Providing appropriate palliative care for patients is a problem that hospitals face worldwide. Nearly 39% of patients and family members cite that there are issues during treatment to initiate these conversations, when they otherwise would like to hold these discussions². A tactic being employed in the health care setting is humor and effectively clarification. Despite the seriousness of these care settings, humor and laughter are common in consults. Humor has come to function as an important tool in facilitating discussions towards advanced directives. Humor operates as a realm of subjective identity and affect that, as noted by sociologist Michael Billig, manifests into "a sense of humor³⁻⁵." This social utility or dependence on humor comes from the ideology that it is a physical and mental cure that can cause a decrease in stress, a boost in morale, and make effective communication obtainable⁴. The overall attitude of humor in clarifying discussions showed great success. Humor served a host of functions at the facility in Germany, the most important of which, were to build therapeutic interrelationships, relieve tension, and to understand the patient's wishes. Humor was also significant for the staff at the facility as it maintained relationships between coworkers, managed the daily stresses of the ward, and it allowed clinicians and their coworkers to maintain a positive perspective on the outlook of their patient's care and management. Patients were more prone to discussing end-of-life care than survival once effective relationships were built. Longer consultation times resulted in stronger and more open relationships to discussing further care. The findings of this study presented the outlook that individuals at the three hundred and ten bed facility in Germany have on palliative care, as well as their varied approaches to initiating care for their patient through protocols such as SPIKES. The team's approach, as observed within the clinic's setting in Germany, lends credit to the need for further cross-cultural analyses to mandate proper training in end-of-life care.