Experiences of silence in end-of-life-care : a phenomenological study

Abstract

This research was undertaken in order to seek a way of acknowledging and understanding the lived experience of people giving and receiving palliative care. Utilising the World Health Organisation’s philosophy of palliative care which underpins the New Zealand philosophy of palliative care, the research explored what was important for the person and family receiving care, and what was of importance to the health professionals providing care at the end-of-life.

Using a phenomenological methodology informed by van Manen and Heidegger, this research incorporated unstructured audio taped interviews with people receiving care, their family members, the bereaved, and members of the interprofessional teams delivering care. The process of being open to the direction participants wanted to journey through this research invited a co-constructed method of engagement. The outcome of the research reveals the lived experience of silence in end-of-life care, incorporating the themes: Silent moments Silence as suffering and compassion Silence as connection Intuitive silence and gratitude Being silent for others Silent meaning of symbolic language

Each narrative offered by participants was a paradigmatic case in its own right, with strong patterns of meaning. The narratives hold rich descriptive information necessary for understanding the role of silence. Silence is a complex phenomenon, with implications on how to ‘be with’ another in the final acts of living. It is a powerful and helpful form of communication and compassionate, supportive companionship. It is person-centred and can convey meaning when there are no easy answers. For health care professionals to be effective with the art and science of silence we must be comfortable in silence ourselves. Our caring intention begins with the self and ripples out to colleagues and supports compassionate communities of care.

This research reconnected with the history of caring for the dying in our community and with some of the ancient wisdoms about silence, offering insights from the past that may support the path to our future.

This research will be of interest to health professionals involved in palliative care, and the research community, highlighting a need to tell our stories and use them to learn and reflect upon the essence of human-to-human connectedness through the role of silence. By doing so we give voice to the less articulated yet important experiences in our practice.