[End of life conflicts in palliative care: a systematic review of the literature].
To evaluate the extent and the quality of the research related to End of life conflicts in palliative care from 1995 to 2004. Accessible Literature of several electronic data bases (BDSP, Cinhal, Cochrane, Francis, Medline, Psychinfo, Saphir, Scopus and Web of science) as well as the grey literature. Studies published in French and English between 1995 and 2004 reporting end of life conflicts, tensions, disagreements, disputes in the context of palliative care. One hundred and two studies were included (87.2% published in English, 12.8% in French). Study designs include revues 27.4%), cross-sections 18.6% and case studies 18.6%. Reported conflicts are related to ethical issues 26.2%, to care 19.1%, to tensions between professionals and patients or families 11.1%, to team experiences 9%. Six studies 5.8% give prevalence figures of conflicts. Half of the studies 51.3% identify possible causes of conflicts: communication issues, euthanasia and suicide assistance demands, autonomy of patients, non respect of advance directives, cultural differences. Ten studies 9.8% identify specifically some effects of the conflicts: moral distress of patients; stress, burn out and guilt of health professionals; lack of trust between doctors and patients or families. Conflicts are mainly resolved through mediation and ethical discussions. Research data on end of life conflicts is scarce at all levels (quantity, quality, methods, social impact, and epistemology). A better understanding of end of life conflict might foster a more adequate management of difficult situations and ultimately a more peaceful death of patients, mourning of families and every day work of health professionals
Mpinga
Emmanuel Kabengele
EK
Unite Ethique et Fin de vie, Institut Universitaire Kurt Bosch/Sion et Institut de Médecine sociale et preventive, Faculté de Médecine, Université de Genève, Suisse.
Chastonay
Philippe
P
Rapin
Charles-Henri
CH
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015984:Causality; D003142:Communication; D003220:Conflict, Psychological; D034462:Dissent and Disputes; D005065:Euthanasia; D006167:Guilt; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D009014:Morals; D015404:Nursing Methodology Research; D010166:Palliative Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology; D011369:Professional-Patient Relations; D011788:Quality of Life / Q000523:psychology; D012107:Research Design; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D013727:Terminal Care / Q000941:ethics / Q000458:organization & administration / Q000523:psychology; D035502:Trust