Navigating goals of care discussion in palliative care: A qualitative study applying Bourdieu's theory of practice

Nowadays, effective communication has become indispensable with the increasing prevalence of advanced life-limiting diseases. Goals of care discussion (GOCD) align care with patients' preferences and improve care quality.

This paper probes deep into the dilemmas and summarizes strategies of medical staff conducting GOCD from the viewpoint of human-environment interaction.

Qualitative study comprising semi-structured in-depth interviews.

Eighteen medical staff (6 doctors, 12 nurses) were recruited from five palliative care units in Guangzhou, China, from December 2023 to March 2024. Data were analyzed by carrying out Braun and Clarke's thematic analysis and guided by Bourdieu's theory of practice.

Three themes and 11 sub-themes emerged: (1) The palliative care environment as a complex and sensitive field characterized by highly sensitive life-related issues, intricate ethical dilemmas, and ambiguous role responsibilities; (2) Multiple forms of capital employed in communication, including informational capital, economic capital, social capital, symbolic capital, and emotional capital; (3) Common communication habitus, including risk aversion, euphemistic expression, emotional restraint.

By drawing on Bourdieu's theory of practice, this study offers revolutionary standpoints on the dilemmas in GOCD within palliative care, which underscores the significance of both individual and environmental factors. Grounded in these insights, we recommend implementing the following strategies: fostering a positive ethical climate and a conducive environment for open dialogue; enhancing ethical awareness and sensitivity through tailored training programs; clarifying relational frameworks to bolster team collaboration; improving communication approaches by leveraging diverse forms of capital; and proactively confronting implicit biases that persist in clinical settings.