Communicative practices in talking about death and dying in the context of Thai cancer care
Issue: Vol 10 No. 3 (2013)
Journal: Communication & Medicine
This article explores communicative practices surrounding how nurses, patients and family members engage when talking about death and dying, based on study conducted in a province in northern Thailand. Data were collected from three environments: a district hospital (nine cases), district public health centres (four cases), and in patients’ homes (27 cases). Fourteen nurses, 40 patients and 24 family members gave written consent for participation. Direct observation and in-depth interviews were used for supplementary data collection, and 40 counselling sessions were recorded on video. The raw data were analysed using Conversation Analysis. The study found that Thai counselling is asymmetrical. Nurses initiated the topic of death by referring to the death of a third person – a dead patient – with the use of clues and via list-construction. As most Thai people are oriented to Buddhism, religious support is selected for discussing this sensitive topic, and nurses also use Buddhism and list-construction to help their clients confront uncertain futures. However, Buddhism is not brought into discussion on its own, but combined with other techniques such as the use of euphemisms or concern and care for others.
Author: Pairote Wilainuch
Atkinson, J. M. (1994 ) Our Masters’ Voices. New York: Routledge.
Atkinson, J. M. and Heritage, J. (1984) Transcription notation. Structures of Social Action: Studies in Conversation Analysis, x–xvi. Cambridge: Cambridge University Press.
Beach, W. A. and Anderson, J. K. (2003) Communication and cancer? Part II: Conversation Analysis. Journal of Psychosocial Oncology 21 (4): 1–22. http://dx.doi.org/10.1300/J077v21n04_01
Bor, R. and Miller, R. (1988) Addressing ‘dreaded issues’: A description of a unique counselling intervention with patients with AIDS/HIV. Counselling Psychology Quarterly 1 (4): 397–406. http://dx.doi.org/10.1080/09515078808254225
Burnard, P. and Naiyapatana, W. (2004) Culture and Communication in Thai Nursing. Cardiff: University of Wales College of Medicine.
Collins, S. (2005) Communicating for a clinical purpose: Strategy in interaction in healthcare consultations. Communication & Medicine 2 (2): 111–122. http://dx.doi.org/10.1515/come.2005.2.2.111
Copp, G. (1998) A review of current theories of death and dying. Journal of Advanced Nursing 28 (2): 382–390. http://dx.doi.org/10.1046/j.1365-2648.1998.00794.x
Drew, P. (2006) When documents ‘speak’: Documents, language and interaction. In P. Drew, G. Raymond and D. Weinberg (eds) Talk and Interaction in Social Research Methods, 63–80. London: Sage.
Drew, P. and Heritage, J. (eds) (1992) Talk at Work: Interaction in Institutional Settings. Cambridge: Cambridge University Press.
Heritage, J. and Greatbatch, D. (1986) Generating applause: A study of rhetoric and response at party political conferences. American Journal of Sociology 19 (92): 110–157. http://dx.doi.org/10.1086/228465
Heritage, J. and Maynard, D. W. (2006) Communication in Medical Care Interaction Between Primary Care Physicians and Patients. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511607172
Illich, I. (1995) Limits to Medicine. London: Marion Boyars.
International Agency for Research on Cancer (2008) World Cancer Report 2008. Lyon: WHO and IARC.
Jefferson, G. (1990) List-construction as a task and resource. In G. Psathas (ed.) Interaction Competence, 63–92. Lanham, MD: University Press of America.
Jones, A. (2003) Nurses talking to patients: Exploring conversation analysis as means of researching nurse–patient communication. International Journal of Nursing Studies 40: 609–618. http://dx.doi.org/10.1016/S0020-7489(03)00037-3
Lerner, G. H. (1994) Responsive list construction: A conversational resource for accomplishing multifaceted social action. Journal of Language and Social Psychology 13: 20–33. http://dx.doi.org/10.1177/0261927X94131002
Lutfey, K. and Maynard, D. W. (1998) Bad news in oncology: How physician and patient talk about death and dying without using those words. Social Psychology Quarterly 61 (4): 321–341. http://dx.doi.org/10.2307/2787033
Maguire, P. and Faulkner, A. (1988) Communicate with cancer patients: 1. Handling bad news and difficult questions. British Medical Journal 297: 907–909. http://dx.doi.org/10.1136/bmj.297.6653.907
Maharajnakorn Chiangmai Hospital and Faculty of Medicine Chiangmai Hospital (2014) Suandok’s Palliative Care Model. Chiangmai: Nursing Service Division, Maharajnakorn Chiangmai Hospital. Retrieved from http://www.med.cmu.ac.th/hospital/nis/palliative.html
Maynard, D. W. (2003) Bad News, Good News: Conversational Order in Everyday Talk and Clinical Settings. Chicago: University of Chicago Press.
McLeod, J. (2001) Qualitative Research in Counselling and Psychotherapy. London: Sage.
Miller, R. and Bor, R. (1991) AIDS: A Guide to Clinical Counseling. Philadelphia: Science Press.
Peberdy, A. (2000) Spiritual care of dying people. In D. Dickenson, M. Johnson and J. Samson Katz (eds) Death, Dying and Bereavement. Second Edition, 73–81. London: The Open University in association with Sage.
Peräkylä, A. (1993) Invoking a hostile world: Discussing the patient’s future in AIDS counselling. Text 13 (2): 291–316. http://dx.doi.org/10.1515/text.1.1918.104.22.1681
Peräkylä, A. (1995) AIDS Counselling: Institutional Interaction and Clinical Practice. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511597879
Peräkylä, A. (2005) Analyzing talk and text. In N. K. Denzin and Y. S. Lincoln (eds) The Sage Handbook of Qualitative Research. Third Edition, 869–886. London: Sage.
Peräkylä, A. and Bor, R. (1990) Interactional problems of addressing ‘dreaded issues’ in HIV counselling. AIDS Care 2 (4): 325–338. http://dx.doi.org/10.1080/09540129008257748
Peräkylä, A. and Vehviläinen, S. (2003) Conversation analysis and the professionalstocks of interactional knowledge. Discourse & Society 14 (6): 727–750. http://dx.doi.org/10.1177/09579265030146003
Ptacek, J. T. and Eberhardt, T. L. (1996) Breaking bad news: A review of literature. Journal of the American Medical Association 276 (6): 496–502. http://dx.doi.org/10.1001/jama.1996.03540060072041
Sepúlveda, C., Marlin, A., Yoshida, T. and Ullrich, A. (2002) Palliative care: The World Health Organization’s global perspective. Journal of Pain and Symptom Management 24 (2): 91–96. http://dx.doi.org/10.1016/S0885-3924(02)00440-2
Silverman, D. and Peräkylä, A. (1990) AIDS counselling: The interactional organisation of talk about ‘delicate’ issues. Sociology of Health & Illness 12 (3): 293–318. http://dx.doi.org/10.1111/1467-9566.ep11347251
Sivaraksa, S. (2005) Conflict, Culture, Change: Engaged Buddhism in a Globalizing World. Somerville, MA: Wisdom.
Srinagarind Hospital (2014) Nursing Guideline for Palliative Care in Srinagarind Hospital. Konkaen: Srinagarind Hospital. Retrieved from http://www.md.kku.ac.th/palliativecare/Guideline.php
Thompson, T. L. and Parrott, R. (2002) Interpersonal communication and health care. In M. L. Knapp and J. A. Daly (eds) Handbook of Interpersonal Communication, 680–725. Thousand Oaks: Sage.
Wilainuch, P. (2011) Communication and Management of Anxiety and Crisis between Thai Public Health Professionals and Patients in Amphoe Wiang Sa, Changwat Nan. Bangkok: University of the Thai Chamber of Commerce.
World Health Organization. (2007) Palliative Care (Cancer Control: Knowledge into Action WHO Guide for Effective Programme; Module 5). Geneva: WHO.
World Health Organization. (2008) Health Situation in the South-East Asia Region 2001–2007. New Delhi: WHO.
World Health Organization (2014) WHO Definition of Palliative Care. Geneva: WHO Retrieved from http://www.who.int/cancer/palliative/definition/en/