Appreciating Clinical Uncertainty in the Acute Care of Older Adults
Research type
Research Study
Full title
Geriatric Medicine, Care and the End of Life: Appreciating Clinical Uncertainty in the Acute Care of Older Adults
IRAS ID
333953
Contact name
Luke Stalley
Contact email
Sponsor organisation
University of Zurich
Duration of Study in the UK
1 years, 5 months, 1 days
Research summary
This is a multi-sited ethnographic study exploring the nature and extent of palliative care in geriatric medical practice amid uncertainty, including how palliative care approaches are reached, how goals of care shift and how these aspects of care are mediated by clinical realities and patient values.
Current policy ambitions seek to provide integrated, coordinated, person-centred palliative and end of life care across specialities and settings. In the UK, older adults are much less likely to receive input from specialist palliative care services, be it consultants in palliative medicine in hospitals or in the care of hospices. The uncertainty that is common to the illness trajectories of older adults living with frailty, multimorbidity and neurodegenerative conditions complicates any straightforward judgements that could be necessitate a shift from a 'curative' to 'palliative' approach. In practice there is instead a careful and flexible continuum of needs-based care.
Geriatric medical specialists are trained in a range of models of care, including palliative and end of life care. These specialists are trained in providing care for patients with uncertain and complex healthcare conditions. Yet the role that palliative care takes in geriatric medicine seems poorly understood outside - and variable within - the speciality. How palliative forms of care are reached for older adults who's conditions and treatment take place in a context of clinical uncertainty, including the contextually sensitive and contingent nature of this care, has received comparatively little attention in research.
Through an ethnographic inquiry into the care practices of hospital-based geriatricians, this study will seek to describe and articulate the ways in which geriatric medical specialists shift to a palliative approach within their care, establish goals of care that make space for palliative approaches, and ultimately strive to deliver good care for older adults who may (or may not be) approaching the end of life.
REC name
Yorkshire & The Humber - Leeds West Research Ethics Committee
REC reference
24/YH/0006
Date of REC Opinion
20 Feb 2024
REC opinion
Further Information Favourable Opinion