Communication contexts about illness, death and dying for people with intellectual disabilities and life-limiting illness.
OBJECTIVE
The general population has been involved in considerable debate about communication and awareness within the context of death and dying. However, there has been little research on how matters of communication on this topic are handled for people with life-limiting illness and intellectual disabilities. This qualitative study explored how staff managed communication about death and dying with people with intellectual disabilities in a Health Service Executive area in Ireland.


METHODS
Ninety-one individuals took part in 16 focus groups. Interviews were analysed using framework analysis.


RESULTS
Participants infrequently discussed death and dying with people with intellectual disabilities. Participants operated most commonly in suspicious awareness environments with people with mild-to-moderate intellectual disabilities, and closed awareness environments with people with severe intellectual disabilities. The majority of participants did not hold absolute opinions that talking about illness, death, and dying with people with intellectual disabilities was "wrong." Rather, they were concerned that their lack of skill and experience in the area would cause harm if they engaged in open conversations. Relatives had an influential role on the process of communication. Participants were strongly motivated to provide quality care and were willing to consider alternative approaches to communication if this would benefit people with intellectual disabilities.


CONCLUSIONS
Although there has been a shift toward conditional open awareness of death and dying in Western society, people with intellectual disabilities have not been afforded the same opportunity to engage in open discussion of their mortality. This study points to the urgent need to engage in debate about this issue in order to ensure that people with intellectual disabilities receive high quality palliative care toward the end of life.
St Francis Hospice, Dublin, Ireland.
Karen
K
Ryan
University College Dublin, School of Psychology, Dublin, Ireland.
Suzanne
S
Guerin
St. Michael's House, Dublin, Ireland; University College Dublin, Centre for Disability Studies, Dublin, Ireland.
Philip
P
Dodd
Midway Services, Co. Meath, Ireland; Dundalk Institute of Technology, School of Nursing, Midwifery and Allied Sciences, Dundalk, Ireland.
John
J
McEvoy
D001291:Attitude of Health Personnel; D003142:Communication; D015897:Comorbidity; D005260:Female; D017144:Focus Groups; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology*; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D010166:Palliative Care / Q000523:psychology* / Q000592:standards; D011368:Professional-Family Relations; D011369:Professional-Patient Relations; D036301:Qualitative Research; D019452:Terminally Ill / Q000523:psychology*