Refinement of a Conceptual Model for Adolescent Readiness to Engage in End-of-Life Discussions.
Journal Article (Journal Article)
Background
Adolescents living with incurable cancer require ongoing support to process grief, emotions, and information as disease progresses including treatment options (phase 1 clinical trials and/or hospice/palliative care). Little is known about how adolescents become ready for such discussions.Objective
The purpose of this study was to explore the process of adolescent readiness for end-of-life preparedness discussions, generating a theoretical understanding for guiding clinical conversations when curative options are limited.Methods
We explored 2 in-depth cases across time using case-study methodology. An à priori conceptual model based on current end-of-life research guided data collection and analysis. Multiple sources including in-depth adolescent interviews generated data collection on model constructs. Analysis followed a logical sequence establishing a chain of evidence linking raw data to study conclusions. Synthesis and data triangulation across cases and time led to theoretical generalizations. Initially, we proposed a linear process of readiness with 3 domains: a cognitive domain (awareness), an emotional domain (acceptance), and a behavioral domain (willingness), which preceded preparedness.Results
Findings led to conceptual model refinement showing readiness is a dynamic internal process that interacts with preparedness. Current awareness context facilitates the type of preparedness discussions (cognitive or emotional). Furthermore, social constraint inhibits discussions.Conclusions
Data support theoretical understanding of the dynamism of readiness. Future research that validates adolescent conceptualization will ensure age-appropriate readiness representation.Implications for practice
Understanding the dynamic process of readiness for engaging in end-of-life preparedness provides clinician insight for guiding discussions that facilitate shared decision making and promote quality of life for adolescents and their families.Full Text
Duke Authors
Cited Authors
- Bell, CJ; Zimet, GD; Hinds, PS; Broome, ME; McDaniel, AM; Mays, RM; Champion, VL
Published Date
- March 2018
Published In
Volume / Issue
- 41 / 2
Start / End Page
- E21 - E39
PubMed ID
- 28114261
Electronic International Standard Serial Number (EISSN)
- 1538-9804
International Standard Serial Number (ISSN)
- 0162-220X
Digital Object Identifier (DOI)
- 10.1097/ncc.0000000000000465
Language
- eng