The challenge to health professionals when carers resist truth telling at the end of life: a qualitative secondary analysis

Aims and objectives: To draw out the similar complexities faced by staff around
truth-telling in a children’s and adult population and to interrogate the dilemmas faced by staff when informal carers act to block truth-telling.

Background: Policy encourages normalisation of death, but carers may act to protect or prevent the patient from being told the truth. Little is known about the impact on staff.

Design: Secondary analysis of data using a supra-analysis design to identify commonality of experiences.

Methods: Secondary ‘supra-analysis’ was used to transcend the focus of two primary studies in the UK, which examined staff perspectives in a palliative children’s and a palliative adult setting, respectively. The analysis examined new theoretical questions relating to the commonality of issues independently derived in each primary study. Both primary studies used focus groups. Existing empirical data were analysed thematically and compared across the studies.

Results: Staff reported a hiding of the truth by carers and sustained use of activities aimed at prolonging life. Carers frequently ignored the advance of end of life, and divergence between staff and carer approaches to truth-telling challenged professionals. Not being truthful with patients had a deleterious effect on staff, causing anger and feelings of incompetence.

Conclusions: Both children’s and adult specialist palliative care staff found themselves caught in a dilemma, subject to policies that promoted openness in planning for death and informal carers who often prevented them from being truthful with patients about terminal prognosis. This dilemma had adverse psychological effects upon many staff.

Relevance to clinical practice: There remains a powerful death-denying culture in
many societies, and carers of dying patients may prevent staff from being truthful with their patients. The current situation is not ideal, and open discussion of this problem is the essential first step in finding a solution.

City visioning and the turn to community:The case of Derry/Londonderry

In the 1980s, urban re-imaging and place marketing were vital elements in the strategies of post-industrial cities aiming to redefine their role, make themselves more competitive and attract global investment and tourists. By the early 1990s, the questionable effects of trickle-down economics on deprived housing estates and the rediscovery of the 'community' as a social partner shifted both the substance and process of vision exercises. This paper examines the experience of building an input into a city vision that aimed to address social and ethno-religious segregation in Derry/Londonderry. Designing a consensus statement for a city that cannot agree its name, was wrecked by bloody violence and has its hinterland fractured by a contested international border, is a difficult and delicate process. The city had a population of 105 800 people in 1998, but is divided by the river Foyle between the mainly Catholic Cityside (to the north and west) and the mainly Protestant Waterside (to the south and east). The analysis connects with the literature on urban policy that emphasises the importance of argumentation and democratic debate in strategic planning and local regeneration (Forester, 1989; Healey, 1996). The paper concludes by arguing that strategies for 'listening' would help to shape a vision that could mobilise community interests around some common urban regional issues and help to promote social and ethno-religious polarisation as mainstream policy concerns.

Replacing the ASBO with the injunction to prevent nuisance and annoyance: a plea for legislative scrutiny and amendment

In May 2013, the Coalition Government introduced a Bill which if passed will streamline the tools available to tackle anti-social behaviour. One of their proposals is to replace the controversial anti-social behaviour order (ASBO) with what is termed an Injunction to Prevent Nuisance and Annoyance (IPNA). Although designed to tackle criminal and sub-criminal behaviour, this new intervention will be a purely civil order replacing the civil-criminal hybrid ASBO. This article explores some of the more troubling aspects of this part of the Bill including its expansive definition of anti-social behaviour, the avoidance of due process protections, the extensive restrictions that respondents may face and the likely impact of its use on young people. With legislation presently under Parliamentary scrutiny, this article calls for amendments to avoid the most problematic aspects of the ASBO being not just replicated but amplified.

Public management, Peace-building and Creating Change: Shifting the Lens of Analysis from the Macro to the Micro

Considerable time, research money and expertise has been spent exploring the complex reality of ethno nationalist conflict and the role that public management plays in supporting the transition from violent conflict to stability, order and prosperity (Esman 1999; Guelke and Milton-Edwards 2000; Brinkerhoff 2005; Brinkerhoff, Wetterberg et al. 2012; Rao 2014). However, there seems to be a gap in relation to the practical challenges of managing change within, through and beyond such conflict. This paper aims to begin the process of putting a framework around the real experience of public management in conflict and transition by shifting the lens of analysis from macros concerns about sequencing interventions (Rao 2014) and legitimate requirements of security, stability and service delivery (Brinkerhoff, Wetterberg et al. 2012) to a micro analysis of the attitudes, behaviours, challenges and compromises held and faced by those public servants on the front line of conflict management and conflict transformation processes. Using senior managers as the unit of analysis and Northern Ireland as an embryonic case study, this paper discusses the links between ethno nationalist societal conflict, public sector reform and manager behaviour. In doing so, it highlights some initial data from an early pilot study into the experiences of individuals in significant public service roles at various stages of the NI conflict / peace process and draws some tentative conclusions about the viability of a wider study.

First-order characteristics of the person-to-vehicle channel at 5.8 GHz

In this paper we investigate the first order characteristics of the radio channel between a moving vehicle and a stationary person positioned by the side of a road at 5.8 GHz. The experiments considered a transmitter positioned at different locations on both the body and receivers positioned on the vehicle. The transmitter was alternated between positions on the central chest region, back and the wrist (facing the roadside) of the body, with the receivers placed on the outside roof, the outside rear window and the inside dashboard of the vehicle. The Rice fading model was applied to the measurement data to assess its suitability for characterizing this emerging type of wireless channel. The Ricean K factors calculated from the data suggest that a significant dominant component existed in the majority of the channels considered in this study.

The difficult-to-treat, therapy-resistant cough: Why are current cough treatments not working and what can we do?

Cough can persist despite exhaustive diagnostic and therapeutic effort and has been termed 'idiopathic' or 'unexplained' but perhaps 'difficult to treat' cough is a more appropriate description. In this article the reasons for poor treatment response are discussed. These include a lack of physician fidelity to management guidelines, patient non-adherence and the lack of effective medicines. A number of randomized controlled trials have been undertaken including low dose opiate therapy, the use of a speech pathology intervention, oral antibiotics and antidepressants. The success or otherwise of such interventions will be discussed. A number of approaches to deal with the problem of 'difficult to treat cough' will be considered.