Collusions Between Patients and Clinicians in End-of-Life Care: Why Clarity Matters

Abstract Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, unreflected behaviors, and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for bo...

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Bibliographic Details
Published in:Journal of pain and symptom management 2017-04, Vol.53 (4), p.776-782
Main Authors: Stiefel, Friedrich, MD, Nakamura, Kenji, MD, Terui, Takeshi, MD, PhD, Ishitani, Kunihiko, MD
Format: Article
Language:English
Subjects:
Aged
Anesthesia & Perioperative Care
Attitude to Death
Collusion
Communication
counter transference
Cultural factors
Culture
Death & dying
Emotions
End of life decisions
Health care
Humans
Injunctions
Liaison
Male
Middle Aged
Pain Medicine
Palliative care
Physician-Patient Relations
Specialization
Terminal Care
transference
Transference (Psychology)
Unconscious (Psychology)
Unconsciousness
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Summary:Abstract Collusion, an unconscious dynamic between patients and clinicians, may provoke strong emotions, unreflected behaviors, and a negative impact on care. Collusions, prevalent in the health care setting, are triggered by situations which signify an unresolved psychological issue relevant for both, patient and clinician. After an introductory definition of collusion, two archetypal situations of collusion—based on material from a regular supervision of a palliative care specialist by a liaison psychiatrist—and means of working through collusion are presented. The theoretical framework of collusion is then described and the conceptual shortcomings of the palliative care literature in this respect discussed, justifying the call for more clarity. Finally, cultural aspects and societal injunctions on the dying, contributing to the development of collusion in end-of-life care, are discussed.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2016.11.011