1. Multiple Professional Visions and Inter- Professional Communication at the End-Of- Life: Challenges for Swiss Doctors Chiara Piccini, Antonella Carassa, Vanessa Alvarado, Brigitte Liebig

2. Piccini, Carassa, Alvarado & Liebig2 The Project NRP 67: End-Of-Life (SNF, 2011-2017) Project: Decision-Making in General Practice Settings at the End of Life (2012-2014)

3. Piccini, Carassa, Alvarado & Liebig 3 Research Questions  What is the role of inter-professional communication in end-of-life decision making?  Which are the main challenges?  Which are the possible strategies to face the perceived challenges?

4. Piccini, Carassa, Alvarado & Liebig 4 Theoretical Framing Inter-professional collaboration is a qualitative indicator of end- of-life palliative care (Kauss et al. 1998, Binder/Wartburg 2009) Good communication practices as a condition of collaboration Inter-relationship between institutional framework (resources and constraints) and communication practice (Piccini/Carassa/Colombetti 2006) Professional visions (Godwin 1994) and communities of practice (Wenger 1998)

5. Piccini, Carassa, Alvarado & Liebig 5 Methods Case studies in 3 language regions of Switzerland, Expert Questionnaires, Expert Interviews Group discussions: 91 Family Doctors (FDs), 72 nurses, and 21 relatives Qualitative analysis of data, Grounded Theory (Glaser/Strauss, 1974) Perspectives of FDs, nurses, and relatives have been triangulated

6. Piccini, Carassa, Alvarado & Liebig 6 Overview of Results

7. Piccini, Carassa, Alvarado & Liebig 7 Findings Relevant information to make decisions appears to be fragmented Fragmented information challenges the quality of care at the end-of-life  loss of decision making quality  unreasonable aggressive treatments and painful death Spontaneous non-institutional communicative strategies prevent fragmentation of information

8. Piccini, Carassa, Alvarado & Liebig 8 Discussion Communication practices rely on interpersonal relationship and the strategies are not elaborated enough with respect to defined processes  This is critical in a globalized multicultural context, characterized also by frequent professional mobility A more flexible retribution system for doctors and arrangements in hospitals work organization may be useful  Development of collaboration practices and alignment between visions