Supportive and palliative care – distinct or part of a continuum?

1. Supportive and palliative care – distinct or part of a continuum? Dr Sue Duke Consultant Practitioner in Cancer and Palliative Care/Senior Lecturer sd11@soton.ac.uk School of Health Sciences

2. Reframing care (Corner and Dunlop 1997) Scrutiny of construction of care (political, social, cultural, physical, emotional) Evaluate impact Deconstruct problem, issue or situation Deconstruct power relationships Reflect on therapeutic processes Introduce care into environment Identify therapeutic role and relationships Reconstruct new approach environment or system

3. Looking for meaning – the value placed within understanding What does supportive care and palliative care mean to different people? What kind of value is placed on each? What is the power relationship between supportive and palliative care? How is this relationship influenced by clinical setting/culture? How does this relationship influence care and professional’s understanding of roles?

4. Meaning can indicate marginalisation • Meanings can marginalise people from appropriate support and symptom management , eg: • People not seen as fitting with the meanings of supportive and palliative care eg people with non-malignant illness or people without diagnosis or without metastatic spread or those waiting for diagnosis or who are currently considered to be free from disease • Meanings marginalise staff from appropriate support to care for people with support and symptom management needs

5. Meanings can serve to enhance power bases Meanings can reinforce professional boundaries Professional boundaries are the place where power is ‘policed’ ...and can be a place where personal boundaries are breached Important to get a balance between appropriate use of resources – the justice of care – and appropriate therapeutic response.

6. Working with meanings Thinking about our practice as travel to differing places in order to understand the meanings provoking referral to describe the architecture beliefs and values and thinking schemas. Understanding these cultural characteristics define the symbolic domain of professional practice the pre-text, the way in which practitioners ‘read’ and respond to the practice so that we can respond to the situation in a way that takes account of these cultural characteristics in order to transform the situation through a participative relationship Duke S (2007)