Why do community healthcare professionals find some conversations difficult?

Janet Nadicksbernd

Research output: ThesisDoctoral Thesis

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Community healthcare professionals can find discussing life-limiting, deteriorating health, and end-of-life difficult to navigate. As a result, communication is limited or poorly done. With the lack of communication, patients/families are more likely to have negative experiences. Also, professionals often avoid conversations, leaving patients/families uninformed and uninvolved with treatment and care decisions, which is at odds with the patients’ legal rights.
Although there is much research on communication, generally, it is either about the patient’s/family perspective or education or training but little on professionals’ perspectives of difficult conversations. This qualitative research explores professionals’ perspectives of conversations that become difficult. It includes professionals’ perceptions of how they interact during these conversations and the differences between the three disciplines under this study: nurses, physiotherapists, and general practitioners.
The methodological approach is interpretivism employing grounded theory approach for analysis. The data collection is in-depth interviews with thirteen professionals, a research diary, and field notes to give a comprehensive understanding of participants’ views.
Findings are that professionals do not see difficult conversations as clearly definable, but they see them within certain contexts and with difficulty levels. Findings indicate that professionals’ thinking, attitudes, and perceptions about difficult conversations are due to patients’/families’ adverse reactions or their own, or both, and/or due to differing expectations between the patient/family and the professional. Other influencers are time, professionals’ mortality, and the uncertainty of a diagnosis, prognosis, or treatment.
A crucial complexity is that professionals find their feelings and emotions dominant influencers, with fear standing out as the main one. Other influencers are work experience, a duty of care, and wanting to feel helpful.
The thesis gives new understandings about professionals’ personalised accounts of having difficult conversations. They help explain why professionals often avoid these conversations which may have implications for education and training, and practice.
Original languageEnglish
Awarding Institution
  • Royal Holloway, University of London
  • Cole, Jennifer, Supervisor
  • Keating, Frank, Supervisor
Publication statusUnpublished - 2023


  • communication
  • community health care professionals
  • emotions
  • grounded theory
  • characteristics of conversations
  • difficult conversations
  • qualitative
  • interviews
  • adverse reactions
  • conflicting expectations
  • fear
  • avoidance
  • managing feelings and emotions
  • emotions, a crucial complexity
  • perceptions of interactions
  • GPs
  • Nurses
  • physiotherapists
  • powerlessness
  • differing expectations
  • conflict
  • education
  • training
  • communication skills
  • sensitive subjects
  • negative feelings and emotions
  • deteriorating health
  • end of life
  • death and dying
  • long term conditions
  • differences between disciplines
  • healthcare
  • professionals

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