Authors (including presenting author) :
YING NG (1), CHAN EA(2)
Affiliation :
(1) Department of Surgery, United Christian Hospital, (2) School of Nursing, The Hong Kong Polytechnic University
Keyword 1: :
Palliative Care
Keyword 2: :
Decision-making Process
Keyword 3: :
Cancer Patients
Keyword 4: :
Lived Experience
Introduction :
As more cancer patients seek better quality of life in the terminal stage, palliative care has become an increasing concern. Although shared decision-making is widely promoted, significant discrepancies remain between acute and palliative care in terms of risk–benefit considerations and prioritization of patient preferences. This creates medical and ethical challenges for acute care nurses, who support palliative care decisions in acute settings. Such complexity highlights the importance of understanding how these nurses navigate the decision-making.
Objectives :
To explore the lived experience of nurses in participating decision-making with cancer patients who require palliative care in acute care settings in Hong Kong.
Methodology :
This qualitative study employed Interpretative Phenomenological Analysis, applying Personal Experiential Themes (PET) and Group Experiential Themes (GET) during the analysis. Semi-structured, one-to-one, face-to-face interviews were conducted between May-September 2024. A purposive sampling of five acute care nurses was recruited. Each nurse had at least two years of experience caring for cancer patients with palliative care needs and in related decision-making within Hospital Authority settings.
Result & Outcome :
Results: Five major themes with 11 sub-themes emerged: 1. Meanings of palliative care 1.1 Fulfilling final wishes 1.2 Finding life meaning 2. Roles and relationships in the process of decision-making 2.1 Perceived roles an as information provider 2.2 Building relationship through communication 3. Living tension arising from competing roles and uneven distribution of professional authority 3.1 Role tension between nurse autonomy and physician authority 3.2 Role tension between acute care identity and palliative care aspiration 3.3 Competing values between acute care and palliative care 4. Consequences of living tension 4.1 Moral distress 4.2 Emotional fatigue arising from over-engagement 5. Meanings of being an acute care nurse in the shadow of palliative care 5.1 Conciliation 5.2 Internal reflection Conclusion: Acute care nurses viewed palliative care as a humanistic practice beyond medical considerations, emphasizing life meaning and built trustful patient-nurse relationships to facilitate decision-making. However, the initially complementary dual roles of acute care nurses within the comprehensive care continuum—envisioned as professional actualization—evolved into competing and conflicting ones, creating tensions around identity, collaboration, and values, leading to moral distress and emotional detachment. Medical decision-making often used as a means of self-protection. Despite these struggles, nurses demonstrated resilience through self-reflection and reconciliation, transforming decision-making challenges into a deeper understanding of palliative care and mutual growth with patients.
