Table 3 Examples of the analysing process
From: Ethical challenges around thirst in end-of-life care –experiences of palliative care physicians
Interview excerpts (interview number, side number and line number) | Generating initial codes of relevance to the research question | Generating themes | Defining and naming themes | Questioning and reflection process from co-authors | Themes of meaning |
|---|---|---|---|---|---|
I put on a drip to see what happens, just because the relatives argue that much, not because the patient needs it. 6: 7–8; 22–24, 1–3. | The pressure of the relatives makes the physician decide to provide a drip, which is not in line with the physician’s assessment of the patients’ needs. | The physician do something against his/her own assessment and starts a drip. | Starting a drip is an ethical challenge. | This physician risks hurting the patient just because he/she cannot withstand pressure from relatives or does not wish to hurt their feelings. This physician needs to prioritize his or her loyalties. The patient’s well-being should trump the relatives’ well-being. | Starting, continuing or discontinuing drips |
We (physicians) assume that patients are not thirsty, without really knowing. 1:3;15. | The physician believe in working routines, but do not really have knowledge about thirst. | The physician question the lack of knowledge among him/her-self and other physicians. | The lack of evidence creates questioning about the working routines around thirst. | The perspective needs to be highlighted - is there a real lack of evidence, or do the informants perceive there is a lack of evidence, or do they acknowledge that they themselves are not well informed, even though there is existing evidence? | Lack of evidence and traditions create doubt. |
If our palliative care unit is responsible for the care, then mouth care is a part of our protocol, of our care. On the other hand, if the patient is at home and the community service is involved, then they are responsible. It happens that they miss this. 8: 3;15–23. | In home care, there are different providers of oral care, who do not have the same routines regarding oral care as the specialised, which means they miss it. | There are providers of oral care that do not have the same routines for oral care, which means that they do not perform it. | Specialist palliative care vs. non-specialist palliative care | I think this is a strange ethical dilemma. It is not about the specialisation, but it is about leaving the care to others? Trusting your colleagues? | Lack of interest and time may result in patient suffering. |