Abstract
Effective patient-centered communication is essential in providing quality care for patients at the end of life. This study aimed to explore the subjectivity of nurses' communication approaches using Q methodology. In this study, 33 Q-samples were constructed based on in-depth interviews with 12 hospice nurses. The Q classification was performed by a total of 38 hospice nurses who had more than 3 years of experience in hospice settings. The collected data were analyzed through the principal component analysis method and the varimax rotation process using the PQ method program. As a result, a total of 4 distinct types emerged: “sincere listener,” “family-centered caregiver,” “resource utilization facilitator,” and “sufficient time devoter.” The factors accounted for 64% of the variance: 19%, 15%, 16%, and 14% respectively. By identifying distinct viewpoints, valuable insights into the diverse perspectives held by nurses in patient-centered communication were gained. Understanding these viewpoints will contribute to the development of tailored communication strategies and training programs. In addition, the study underscores the need for training, resources, and organizational support to enhance nurses' communication skills.
KEY WORDS: communication, end-of-life care, patient-centered nursing, Q methodology
The goal of end-of-life care is to optimize the patient's quality of life in the treatment of their disease and ensure that they die peacefully with comfort and dignity.1 Globally, there is increased demand for palliative and hospice care, which comprehensively evaluates and manages the physical, psychosocial, and spiritual domains, including pain and symptom relief, for patients at the end of life and their families.2 Discussions regarding end of life are not always welcome in a death-averse social context, but when hospice caregivers initiate these conversations and conduct them appropriately, they have the potential to drastically change a dying person's illness experiences.3 Patient-centered communication in end-of-life care can increase treatment satisfaction, reduce the use of aggressive and costly medical services, alleviate the experience of bereavement, and ultimately improve patients' quality of life.4
Nurses' patient-centered communication competencies are essential for dignified end-of-life support. Numerous studies have confirmed that the quality of nurses' communication competency has a very strong correlation with the quality of end-of-life care.5 Nurses play the most important role in direct communication with patients in hospice clinical practices, as they can systematically and comprehensively approach patients 24 hours a day.6 Nurses communicate with patients and their families on sensitive and complex topics such as providing information on life expectancy and predicted changes, deciding whether to discontinue active life-sustaining treatment, and discussing multiple aspects such as the patient's preferences and values to support a dignified end of life.7
However, there are several limitations to patient-centered communication in the nursing care of end-of-life patients. Difficulties in patient-centered communication with end-of-life patients arise from potential emotional and personal impacts, communication skills and training, language and cultural barriers, time constraints, ethical dilemmas, interprofessional collaboration challenges, and the emotional burdens imposed on nurses.4,5,8 Although subjectivity is inherent in all human interactions, it becomes particularly important for nurses in patient-centered communication.9 In the context of patient-centered communication, nurses' subjectivity refers to their personal experiences, beliefs, feelings, and values that influence their approach to patients, which ultimately manifest as actions and attitudes such as empathy, respect, active listening, or shared decision making.10 Thus, understanding nurse subjectivity can help inform strategies and interventions to enhance patient-centered communication and support nurses in providing compassionate and effective care to the end-of-life patient.11
Nevertheless, few studies have confirmed the subjectivity of communication of nurses caring for end-of-life patients. Therefore, this study aimed to promote the understanding of this phenomenon by confirming the subjective frame of reference for nurses' patient-centered communication with end-of-life patients. The results of this study will contribute to the development of knowledge regarding patient-centered communication in clinical nursing practice and serve as a basis for the development of more practical communication education materials for the care of end-of-life patients. They are expected to reflect nurses' subjective judgments and perspectives and lead to the development of nursing-friendly communication guidelines.
METHOD
Study Design
This study used Q methodology to investigate the subjective perspectives of nurses on patient-centered communication. Q methodology is a comprehensive research approach that combines the strengths of qualitative and quantitative methods, facilitating the examination of intricate subjects by transforming human subjectivity into an objective outcome. By enabling the exploration of subjective viewpoints, Q methodology involves a systematic process of sorting statements to capture diverse perspectives and allows identifying shared types through factor analysis. Consequently, this design is suitable for examining the framework of subjective topics such as nurses' perspectives about patient-centered communication, as it aids in comprehending the distinct perspectives held by individuals within a specific group.
Study Procedure
The Q methodology includes 6 practical steps:
formulating a list of statements known as the Q-population from interviews;
creating a final set of Q statements, called the Q-sample, from the Q-population;
selecting participants, called the P-sample, to sort the Q-sample;
sorting the Q-samples using a Q-sort table;
conducting factor analysis using the PQ Method program; and
assigning labels and interpreting the identified factors.
Formulation of the Q-Population and Q-Sample
The Q-population utilized in this study was derived and enhanced through interviews. In-depth interviews were conducted with 12 experienced nurses who had cared for patients at the end of their lives in hospice wards or centers. To minimize researcher bias, semistructured interview questions were used. The specific inquiries posed were as follows: “What aspects do you consider most important when caring for end-of-life patients?” “What are the key factors you prioritize in communicating with patients nearing the end of life?” and “Could you share any memorable experiences related to patient-centered communication with end-of-life patients?” Subsequently, immediately after each interview, research notes were made about the interview's ambiance, participants' demeanor, impressions, and other relevant factors. These notes were then utilized for the extraction of the Q-sample and incorporated into the analysis.
After that, a Q-population was extracted to accurately capture the participants' subjective views on patient-centered communication at end of life. A comprehensive set of statements (175 statements across 8 themes) that reflected various viewpoints, beliefs, and challenges related to patient-centered communication was developed. To reconstruct the Q-population, similar statements were categorized together. Statements that contained more than 2 ideas were separated, and those with repetitive viewpoints were eliminated. Consequently, a Q-sample consisting of 33 Q-statements were compiled, which effectively represented the overall concourse (Table 1).
TABLE 1.
Q Statements
| No. | Statements |
|---|---|
| 1 | For patient-centered nursing, I tend to put a lot of effort into understanding the patient's usual disposition, life process, and disease process. |
| 2 | For patient-centered nursing, efforts are needed to understand the patient's inner thoughts. |
| 3 | It is more important to encourage psychological and emotional stability than focus on physical symptoms, so I tend to pay more attention to providing sufficient explanations, eye contact, warm words, and stroking rather than the treatment or technique itself. |
| 4 | For patient-centered communication, it is helpful to have a meeting with a religious leader to receive spiritual help. |
| 5 | To facilitate communication, it is helpful to encourage participation in various programs (singing, art therapy, etc). |
| 6 | In communication with end-of-life patients, it is important to understand the patients' nonverbal expressions (complexion, posture, etc). |
| 7 | Even if you do not necessarily express it verbally, silent acceptance conveys meanings beyond words. |
| 8 | It is necessary to notice whether it is the time to listen or give information. |
| 9 | Communication with end-of-life patients requires unconditional acceptance of and listening to and empathizing with the patient. |
| 10 | It is necessary to try to think from the patient's perspective. |
| 11 | I try not to use sensitive words in front of the patient that may scare them, such as “death,” “dying,” etc. |
| 12 | If the patient finds it difficult to accept death, it is necessary to speak directly so that he/she can think about it. |
| 13 | It is necessary to allow the patient to tell his/her own story naturally and to listen until the end. |
| 14 | I try to release tension by using humor appropriately. |
| 15 | When death is imminent, it is necessary to take care with actions rather than words (playing the patient's favorite music, etc.). |
| 16 | I think that communication with the caregiver than with the patient is more important in a near-death situation. |
| 17 | As a nurse, I sometimes share my personal stories, trying to find common interest with patients. |
| 18 | Even if the patient is defensive, it is necessary to make an effort to continue the conversation. |
| 19 | The professionalism of a nurse naturally leads the conversation. |
| 20 | It is difficult for me to listen to and accept patients when I am tired, so I usually try to control my physical strength and emotions as a nurse. |
| 21 | The ward atmosphere, which takes patient-centered nursing for granted, affects the communication style and attitude of nurses. |
| 22 | I think it helpful to intentionally use medical terminology to communicate with patients to build trust. |
| 23 | Because patients trust the doctor's words more than the nurse's, I think that the doctor should be responsible for direct explanations about death or life expectancy. |
| 24 | Prompt and appropriate responses to patient symptoms are important for rapport formation. |
| 25 | Prompt and appropriate action on patient symptoms is important for rapport formation. |
| 26 | What is important for patient-centered communication is sincerity and interest in treating patients. |
| 27 | For patient-centered communication, it is necessary for the nurse to approach the patient with an open attitude. |
| 28 | When a patient has hallucinations due to end-stage delirium, I tend to simply tell them that this is not the case and orient them. |
| 29 | For communication education, it can be helpful to watch education videos or simulations rather than texts or lectures. |
| 30 | If online programs (chatbots, virtual simulations, etc.) are used in communication education for nurses, I think I will be able to practice communication comfortably without fear of making mistakes. |
| 31 | In order to understand and communicate with patients and families, I constantly question seniors and fellow nurses and try to learn tips from them. |
| 32 | Nurses who lack empathy or are usually blunt seem to have more difficulty adjusting to hospice care. |
| 33 | The perspective of a hospice nurse should be different from that of a general ward nurse, as the patient's overall change should be discussed and consulted upon. |
Selecting P-Samples
A purposive sample of nurses with experience in end-of-life care was selected. Demographic information, including years of experience, current position, previous clinical experience, and specialization, was considered to ensure a diverse representation of perspectives.
Sorting the Q-Samples Using a Q-Sort Table
Q sorting is a data collection technique used in Q methodology to capture the subjective viewpoints of participants. During Q sorting, the participants were presented with a set of statements, called Q-samples, that represented different perspectives. These statements were displayed on a computer screen. The participants were instructed to sort the statements into a predefined pyramid-shaped distribution pattern, called the Q-sort table. The Q-sorting grid included categories from “strongly disagree” to “strongly agree.” The participants were asked to place each statement in the appropriate category based on their personal agreement or disagreement with the statement. The sorting process required participants to make decisions about the relative positioning of the statements, indicating their perceived importance, relevance, or agreement with each statement. This allowed the participants to express their subjective viewpoints and preferences regarding patient-centered communication.
The process was conducted individually to prevent group influence and encourage the participants to freely express their perspectives, because it is important that Q sorting be a subjective process, as participants interpret and rank the statements based only on their own experiences, beliefs, and attitudes. Finally, additional information was gathered to further interpret the Q-factor by asking the participants why they had sorted the cards into the 2 extremes.
Factor Analysis and Assigning Labels
The data collected from the Q sorting process was subjected to factor analysis to identify patterns and types representing distinct viewpoints on patient-centered communication among nurses caring for end-of-life patients.
To analyze the 34 individual Q-sorts, the software program PQ Method 2.35 was utilized to conduct a principal component factor analysis and varimax rotation. This statistical analysis allowed identifying 4 distinct types that represented a shared perspective among the participants involved in the study. For each of these discrete factors, the set of distinguishing statements and their average rankings were reported, ranging from most strongly disagree (−4) to most strongly agree (+4). To interpret the characteristics of these factors, the statements that generated the strongest agreement or disagreement (P < .05) were focused on, with close attention to those with P values lower than 1%. Finally, descriptive labels were assigned to each type to represent the interpreted characteristics they encapsulated.
Ethical Considerations
The participants in the study were provided with a comprehensive explanation of the study's purpose and were informed that their participation was voluntary. After the detailed explanation, all study participants completed a consent form. The research protocol had been approved in advance by the institutional review board of the author's institution, and permission to conduct the study was obtained from each relevant hospital or facility involved.
RESULTS
Factor analysis revealed 4 distinct viewpoints on patient-centered communication among nurses caring for end-of-life patients. Each viewpoint is described below, along with their assigned names. The factors accounted for 64% of the variance: 19%, 15%, 16%, and 14% respectively (Table 2). In Q methodology, the focus is on identifying factors rather than emphasizing their proportions. The standard criterion for type selection is whether a factor has an eigenvalue greater than 1, as an eigenvalue exceeding 1 is typically considered to ensure factor reliability and indicates statistical significance.12 Therefore, in this study, the revealed factors were statistically significant, as all 4 factors had eigenvalues exceeding 1: 16.82, 2.73, 2.61, and 2.16, respectively (Table 2). Furthermore, Table 3 presents Q-sentences where the characteristics of each type are distinct from the others (Table 3).
TABLE 2.
Eigenvalue, Variance, and Cumulative Percentages
| Variables | Type I | Type II | Type III | Type IV |
|---|---|---|---|---|
| Eigenvalue | 16.82 | 2.73 | 2.61 | 2.16 |
| Variance (%) | 19 | 15 | 16 | 14 |
| Cumulative percentage | 19 | 34 | 50 | 64 |
TABLE 3.
Distinguishing Statements for Each Type (Over ±1.00, P < .05)
| Type | No. | Statements | Z Score |
|---|---|---|---|
| I | 26a | What is important for patient-centered communication is sincerity and interest in treating patients. | 2.26 |
| 1a | For patient-centered nursing, I tend to put a lot of effort into understanding the patient's usual disposition, life process, and disease process. | 1.50 | |
| 13b | It is necessary to allow the patient to tell his/her own story naturally and to listen until the end. | 1.28 | |
| 16b | I think that communication with the caregiver than with the patient is more important in a near-death situation. | −1.53 | |
| 23b | Because patients trust the doctor's words more than the nurse's, I think that the doctor should be responsible for direct explanations about death or life expectancy. | −1.66 | |
| II | 16a | I think that communication with the caregiver than with the patient is more important in a near-death situation. | 1.88 |
| 7b | Even if you do not necessarily express it verbally, silent acceptance conveys meanings beyond words. | 1.35 | |
| 9a | Communication with end-of-life patients requires unconditional acceptance of and listening to and empathizing with the patient. | −1.56 | |
| III | 4a | For patient-centered communication, it is helpful to have a meeting with a religious leader to receive spiritual help. | 1.21 |
| 5a | To facilitate communication, it is helpful to encourage participation in various programs (singing, art therapy, etc). | 1.19 | |
| 16b | I think that communication with the caregiver than with the patient is more important in a near-death situation. | −1.00 | |
| 18a | Even if the patient is defensive, it is necessary to make an effort to continue the conversation. | −1.39 | |
| IV | 2b | For patient-centered nursing, efforts are needed to understand the patient's inner thoughts. | 1.79 |
| 33a | The perspective of a hospice nurse should be different from that of a general ward nurse, as the patient's overall change should be discussed and consulted upon. | 1.38 | |
| 25b | Prompt and appropriate action on patient symptoms is important for rapport formation. | 1.23 | |
| 3a | It is more important to encourage psychological and emotional stability than focus on physical symptoms, so I tend to pay more attention to providing sufficient explanations, eye contact, warm words, and stroking rather than the treatment or technique itself. | −1.26 |
aSignificant at P < .01.
bSignificant at P < .05.
Of the 38 P-samples, 29 were loaded significantly on the defined 4 types and identified as a representative sample. Following the Q methodology procedure, the remaining 9 Q-sorts that did not load significantly on any factor were excluded from the results.12,13 The P-samples' characteristics, including age, educational level, and clinical experience, were evenly distributed across the 4 factors. The average clinical experience was 11.03 years, and the average hospice ward experience was 4.99 years.
Type 1: Sincere Listener
Type 1 consisted of 11 participants, including 6 general nurses, 2 charge nurses, and 3 head nurses. The average clinical experience was the highest in this type at 13.53 years and hospice ward experience was 4.84 years. Type 1, labeled as “sincere listener,” emphasized the importance of active listening and empathetic engagement. Nurses holding this perspective prioritized creating a safe and trusting environment where patients feel comfortable expressing their thoughts and emotions. They valued a deep understanding of the patient as a single person, including their needs, interests, experiences, and endeavors to validate patients' experiences through attentive and compassionate communication. Participants categorized in this type associated qualities such as empathy, perseverance, and genuine interest as key attributes for effective patient-centered communication, and this led them to take professional pride in caring for patients as nurses. Examples include the following:
I believe that the basis of patient-centered communication begins with sincerity towards patients and interest in them. This is because we believe that nursing care itself must first be based on the interests of the patient in order to deeply understand and care for the patient.
(The most important thing in patient-centered communication) is listening. When you sincerely sympathize with and listen to the patient's situation at the end of life, you can figure out what the patient really wants. You can have meaningful communication when you approach patients with sincerity. In this way, trust can be built up more deeply. Even in a dying situation, rather than communication with family members, it is important to try to understand what is uncomfortable and difficult through the patient's non-verbal expressions.
The most important thing in communication is not to forget that the patient is a person just like us. If the patient is framed and seen only as a sick person, the individual patient's situation, difficulties, discomfort, and needs of the patient may be less noticeable.
The nurses are thought to be the staff with whom patients have the most time contact in the ward. They face patients continuously 24 hours a day and consequently have more rapport.
Type 2: Family-Centered Caregiver
Type 2 consisted of 6 participants, including 5 general nurses and 1 charge nurse. The average clinical experience was 7.5 years and hospice ward experience was 4.67 years. Type 2, labeled “family-centered caregiver,” focused on the significance of involving and supporting the patient's family in the communication process. Nurses with this perspective recognized the essential role of family members as primary caregivers and decision makers. They prioritized building strong partnerships with families as well as patients, providing them with information and emotional support and involving them in care planning and decision making. Furthermore, they valued attentive care rather than communication itself and believed that, at certain times, silence holds more significance than constantly trying to engage in conversation. Examples include the following:
Because patients are often unconscious, nurses have more communication with their families. They are often anxious and dependent on nurses because they have rarely experienced the death of a family member. Therefore, communication with family members is also important.
Rather than saying something, I think silence and the atmosphere in the sense of cheering and supporting patients are more important. Empathy and acceptance are helpful for smooth communication, but I think unconditional acceptance is unnecessary.
Type 3: Resource Utilization Facilitator
Type 3 consisted of 6 general nurses with an average clinical experience of 10.83 years and hospice ward experience of 3.5 years. Type 3, labeled “resource utilization facilitator,” emphasized the efficient use of resources and information to enhance patient-centered communication. Nurses holding this perspective recognized the value of incorporating various approaches instead of solely relying on methods to initiate conversations, including religious support and participation in diverse programs, to optimize communication outcomes. They acknowledged the role of religion in providing comfort and spiritual guidance to patients, going beyond technical communication to address their emotional and existential needs. This perspective underscored the importance of utilizing available resources, such as religious support services and participation in music or art programs. It facilitated effective and holistic patient-centered communication to overcome communication barriers and ensure effective information exchange. Examples include the following:
The stability of mind that patients who are nearing death get from religion is really important. Even for nonreligious people, religion can help them prepare to face the death ahead more fearlessly and comfortably.
Since each person has a different personality, disposition, attitude toward others, and attitude toward death, it is not appropriate to provoke a patient who does not like to talk by continuously trying talking to him. For patients who lie down most of the time and receive similar treatments repeated every day, participation in various programs becomes a source of vitality in their difficult hospital life, and it helps in better communication.
Type 4: Sufficient Time Devoter
Type 4 consisted of 7 participants, including 4 general nurses, 2 charge nurses, and 1 head nurse. The average clinical experience was 12.27 years, and the hospice ward experience was the highest at 6.97 years. Type 4, labeled as “sufficient time devoter,” highlighted the significance of allocating ample time for patient-centered communication and adopting a holistic approach to care. Nurses holding this perspective prioritized unhurried interactions, recognizing the importance of dedicating sufficient time to understand patients' physical, emotional, and psychosocial needs. They aimed to engage in comprehensive assessments, actively listen to patients' concerns, observe subtle changes in patients' condition or well-being, and take immediate action for patient needs. This viewpoint emphasized the value of taking a comprehensive and holistic approach to patient-centered communication, ensuring that patients' evolving needs are thoroughly understood and addressed. By devoting sufficient time and attention, nurses can establish a deep connection with patients, enabling them to provide personalized and responsive care throughout the end-of-life journey. Examples include the following:
I think that proper patient-centered communication is possible only when I have enough information about the patient. It is important to secure absolute time devoted to communication with patients to form rapport. In communication, rapport is needed the most, and it comes from actions, not words. Providing competent and precise care is a fundamental foundation for building relationships with patients and strengthening the therapeutic relationship.
By devoting more time to the patient, I try to understand the patient's difficulties and take care of the patient as a whole.
DISCUSSION
The results of this study revealed 4 distinct viewpoints on patient-centered communication among nurses caring for end-of-life patients: sincere listeners, family-centered caregivers, resource utilization facilitators, and sufficient time devoters. This distinction provides valuable insights into the diverse perspectives of nurses in approaching patient-centered communication in end-of-life care settings.
The “sincere listener” viewpoint emphasizes the importance of active listening and empathetic engagement. Nurses holding this perspective recognize the significance of creating a safe and trusting environment in which patients feel heard and validated. This finding aligns with previous research highlighting the central role of empathy and active listening in establishing therapeutic relationships and improving patient outcomes.14 By being a sincere listener, nurses show respect for the patient and actively listen to their thoughts, concerns, and desires.15 This allows nurses to understand patients' unique perspectives and preferences, ensuring that care is tailored to their individual needs and promoting autonomy and dignity.7
The emphasis on deep understanding and validation suggests the need for communication training programs that enhance nurses' empathy skills and encourage patient-centered dialogue. However, nurses may not receive comprehensive training in these areas, leading to a lack of confidence and competence in engaging in end-of-life conversations.16 Inadequate training can make it challenging for nurses to navigate sensitive topics, address patients' emotional needs, and facilitate shared decision making.7 Providing nurses with comprehensive education and training in end-of-life communication skills is crucial. Training programs should focus on active listening and empathy, delivering bad news, facilitating end-of-life discussions, and addressing emotional needs. Equipping nurses with effective communication techniques enables them to communicate more efficiently and confidently with end-of-life patients.
The “family-centered caregiver” viewpoint highlights the essential role of family involvement in the communication process. This perspective aligns with the growing recognition of the importance of family-centered care in end-of-life settings.17 By adopting a family-centered approach, nurses acknowledge and value the family's presence, involvement, and contribution to the patient's well-being. Recognizing the family as an integral part of the care team promotes collaboration and strengthens overall care.8 Nurses who align this viewpoint prioritize building strong partnerships with families, acknowledging their unique experiences and perspectives.
These findings suggest the need for interventions that support nurses in fostering collaborative relationships with families, including education on effective communication strategies that engage and empower families in decision-making processes. The unpredictability and complexity of end-of-life situations pose communication challenges for nurses. Dying trajectories can be unpredictable, leading to uncertainties in prognostication and decision making.18 This uncertainty can make it difficult for nurses to provide clear and concise information to families, resulting in increased anxiety and confusion. Communicating complex medical information in a sensitive and understandable manner requires skill and experience.19 Nurses play a crucial role in facilitating discussions and involving families in making informed decisions about the care and treatment of their loved ones. By educating nurses on communication techniques that promote active participation and shared decision making, they can enhance families' sense of involvement and empowerment.
The “resource utilization facilitator” viewpoint emphasizes the efficient use of resources, including religious support and program participation, to enhance patient-centered communication. As facilitators of resource utilization, nurses can actively engage with a multidisciplinary team to coordinate and optimize the use of resources.20 This perspective recognizes the value of incorporating diverse approaches to address patients' emotional and spiritual needs. This finding is consistent with recent research highlighting the benefits of incorporating spiritual care into end-of-life communication.21
The inclusion of religious support and program participation in communication practices highlights the importance of interdisciplinary collaboration and provision of training and resources to nurses. Integrating spiritual care into end-of-life communication has been shown to positively impact patients' well-being and quality of life.22 By fostering collaboration and offering appropriate training, health care organizations can equip nurses with the knowledge and skills to effectively address the spiritual and religious needs of patients, promoting comprehensive and person-centered care.23
The fourth viewpoint was termed is the “sufficient time devoter.” By devoting sufficient time, a nurse can spend quality time with the patient, conduct comprehensive assessments, and actively listen to and gather essential information.24 This enables the nurse to develop an individualized care plan that addresses the unique needs and preferences of the patient, thereby enhancing the quality of care provided. This aligns with recent research emphasizing the importance of sufficient time and comprehensive assessments in end-of-life care.25
The findings of this study underscore the importance of supporting nurses in managing their workloads and ensuring sufficient time for meaningful communication between patients and families. Nurses often face heavy workloads and time constraints in clinical practice. This can limit the amount of time available for in-depth communication with dying patients.26 The pressure to complete documentation promptly can lead to rushed or minimal communication, particularly with dying patients who may require more time and attention.27 Health care organizations can review workflows and processes to identify opportunities for optimizing time management. This may involve streamlining documentation tasks, redistributing workload, or implementing strategies to reduce nonessential administrative tasks. Health care organizations can establish policies and create environments that prioritize patient-centered communication.28 Flexible scheduling, interdisciplinary collaboration, and supportive supervision can contribute to an environment that values and facilitates effective communication.
In conclusion, this study identified 4 distinct perspectives on patient-centered communication among nurses caring for end-of-life patients. Understanding and recognizing these perspectives can provide a foundation for tailored communication and training programs. By aligning communication practices with these diverse perspectives, health care professionals can enhance patient-centered care in end-of-life settings, ultimately improving the end-of-life experience of patients and their families.
Future research could delve into the factors influencing the adoption of specific viewpoints, such as individual characteristics, organizational culture, and educational background. Understanding these factors could inform the development of targeted interventions and strategies to promote patient-centered communication among nurses. Moreover, exploring the potential challenges and barriers faced by nurses in implementing these perspectives could offer insights into areas for improvement and inform the development of supportive policies and resources.
Footnotes
Author contributions: CREDIT authorship contribution statement: conceptualization, Eunhye Jeong; search and literature review, Eunhye Jeong, A Young Han; data curation, Eunhye Jeong, A Young Han; formal analysis, Eunhye Jeong, A Young Han; writing—original draft preparation, Eunhye Jeong, A Young Han; writing—review and editing, Eunhye Jeong, A Young Han. Both authors have read and agreed to this version of the manuscript.
This work was supported by the Shihan University Research Fund, 2021.
The authors have no conflicts of interest to disclose.
Contributor Information
Eunhye Jeong, Email: ehjeong.shu@gmail.com.
A Young Han, Email: ayounghan@scnu.ac.kr.
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