Exploring symptom meaning: perspectives of palliative care physicians.
CONTEXT
Understanding patients' symptom experiences is essential to providing effective clinical care. The discussion between patients and physicians of symptom meaning and its significance, however, is ill understood.


OBJECTIVES
To investigate palliative care physicians' understanding of symptom meaning, and their experiences of and attitudes towards the discussion of symptom meaning with patients.


METHODS
Semi-structured interviews were conducted (N = 17) across Sydney, Australia. Transcripts were analysed using framework analysis.


RESULTS
Six key themes were identified: (1) definitions of symptom meaning (causal meanings, functional impact, existential impact, and cascade of meanings); (2) meanings are personal (demographic, culture, spiritual, and family differences); (3) eliciting meanings requires subtlety and trust (following the patient's cues); discussing meaning can be (4) hard (for the patient and health professional); (5) therapeutic (assuaging fears, feeling listened to and valued, increased sense of control, and reduced symptom distress); and (6) enhances clinicians' practice and work satisfaction (provision of more tailored care, reassurance through the provision of information, and strengthening of doctor-patient relationship).


CONCLUSIONS
Exploring symptom meaning can serve to provide information, alleviate anxiety, and facilitate individualised care, but only when patients present cues or are open to discuss symptom-related concerns. However, various barriers hinder such dialogue in consultations. Greater awareness of symptom meaning and its influence may facilitate physicians exploring symptom meaning more with patients in the future.
['Estacio|Celina F|CF|http://orcid.org/0000-0001-5007-4604', 'Butow|Phyllis N|PN|', 'Lovell|Melanie R|MR|', 'Dong|Skye T|ST|', 'Clayton|Josephine M|JM|']
D000328:Adult D000368:Aged D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010166:Palliative Care D010820:Physicians D036301:Qualitative Research
Symptom meaning Palliative care Symptom experience Health professionals Advanced cancer Qualitative research