Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T10:24:18.226Z Has data issue: false hasContentIssue false
  • English
  • Français

Collusion in palliative care: an exploratory study with the Collusion Classification Grid

Published online by Cambridge University Press:  10 April 2019

Friedrich Stiefel ,
Kenji Nakamura ,
Kunihiko Ishitani ,
Céline Bourquin  and
Michael Saraga
Friedrich Stiefel*
Affiliation:
Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Switzerland
Kenji Nakamura
Affiliation:
Higashi Sapporo Hospital, Sapporo, Japan
Kunihiko Ishitani
Affiliation:
Higashi Sapporo Hospital, Sapporo, Japan
Céline Bourquin
Affiliation:
Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Switzerland
Michael Saraga
Affiliation:
Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Switzerland
*
Author for correspondence: Friedrich Stiefel, Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Les Allières, Av. de Beaumont 23, 1011 Lausanne, Switzerland. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Collusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.

Method

Situations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.

Result

1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.

Significance of results

This case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.

Keywords

CollusionCollusion classification gridCountertransferencePalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 637 - 642
Copyright
Copyright © Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Armstrong, D (1987) Silence and truth in death and dying. Social Science & Medicine 24(8), 651–657.Google Scholar
Balint, M (1955) The doctor, his patient, and the illness. Lancet 268(6866), 683–688.Google Scholar
Bell, K (2014) The breast-cancer-ization of cancer survivorship: Implications for experiences of the disease. Social Science & Medicine 110, 56–63.Google Scholar
Chaturvedi, SK, Loiselle, CG and Chandra, PS (2009) Communication with relatives and collusion in palliative care: A cross-cultural perspective. Indian Journal of Palliative Care 15(1), 2–9.Google Scholar
Crowe, S, Clarke, N and Brugha, R (2017) 'You do not cross them': Hierarchy and emotion in doctors' narratives of power relations in specialist training. Social Science & Medicine 186, 70–77.Google Scholar
Davis, MP, Bruera, E and Morganstern, D (2013) Early integration of palliative and supportive care in the cancer continuum: Challenges and opportunities. American Society of Clinical Oncology - Educational Book, 144–150.Google Scholar
Faulkner, A (1998) ABC of palliative care. Communication with patients, families, and other professionals. British Medical Journal 316(7125), 130–132.Google Scholar
Fox, R and Carey, LA (1999) Therapists' collusion with the resistance of rape survivors. Clinical Social Work Journal 27(2), 185–201.Google Scholar
Frankel, J (1993) Collusion and intimacy in the analytic relationship. In The legacy of Sandor Ferenczi. Aron, L and Harris, A (eds.), pp. 227–247. Hillsdale, NJ: Analytic Press.Google Scholar
Gosney, M (2007) Contribution of the geriatrician to the management of cancer in older patients. European Journal of Cancer 43(15), 2153–2160.Google Scholar
Helft, PR (2005) Necessary collusion: Prognostic communication with advanced cancer patients. Journal of Clinical Oncology 23(13), 3146–3150.Google Scholar
Jacobs, TJ (1999) Countertransference past and present: A review of the concept. International Journal of Psychoanalysis 80, 575–594.Google Scholar
Lempp, H and Seale, C (2004) The hidden curriculum in undergraduate medical education: Qualitative study of medical students' perceptions of teaching. British Medical Journal 329(7469), 770–773.Google Scholar
Low, JA, Kiow, SL, Main, N, et al. (2009) Reducing collusion between family members and clinicians of patients referred to the palliative care team. The Permanente Journal 13(4), 11–15.Google Scholar
Montgomery, SL (1991) Codes and combat in biomedical discourse. Science as Culture 2(3), 341–391.Google Scholar
Nivoli, GC, Lorettu, L, Milia, P, et al. (2014) Il contagio e la collusione suicidaria tra terapeuta e paziente [Suicidal contagion and collusion between therapist and patient]. Rivista di Psichiatria 49(6), 279–287.Google Scholar
Nos, JP (2014) Collusive induction in perverse relating: perverse enactments and bastions as a camouflage for death anxiety. International Journal of Psychoanalysis 95(2), 291–311.Google Scholar
Petriglieri, G and Wood, JD (2003) The invisible revealed: Collusion as an entry to the group unconscious. Transactional Analysis Journal 33(4), 332–343.Google Scholar
Schaad, B, Bourquin, C, Bornet, F, et al. (2015) Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center. Patient Education and Counseling 98(6), 771–776.Google Scholar
Schwarz, JK (2004) Responding to persistent requests for assistance in dying: A phenomenological inquiry. International Journal of Palliative Nursing 10(5), 225–235.Google Scholar
Stiefel, F, Nakamura, K, Terui, T, et al. (2017a) Collusions between patients and clinicians in end-of-life care: Why clarity matters. Journal of Pain and Symptom Management 53(4), 776–782.Google Scholar
Stiefel, F, Nakamura, K, Terui, T, et al. (2017b) A comment to Shinjo, T et al.: collusion in VSED. (Response to Shinjo, T, Morita, T, Kiuchi, D, et al. Japanese physicians’ experiences of terminally ill patients voluntarily stopping eating and drinking: a national survey. BMJ Supportive & Palliative Care. Published Online First: 08 November 2017. doi: 10.1136/bmjspcare-2017-001426).Google Scholar
Stiefel, F, Nakamura, K, Terui, T, et al. (2018) The Collusion Classification Grid: A supervision and research tool. Journal of Pain and Symptom Management 55(2), e1–e3.Google Scholar
Stiefel, F and Krenz, S (2013) Psychological challenges for the oncology clinician who has to break bad news. In New Challenges in Communication with Cancer Patients. Antonella, S (ed.), pp. 51–62. New York: Springer.Google Scholar
The, AM, Hak, T, Koeter, G, et al. (2000) Collusion in doctor-patient communication about imminent death: An ethnographic study. British Medical Journal 321(7273), 1376–1381.Google Scholar
Willi, J (1984) The concept of collusion: A combined systemic-psychodynamic approach to marital therapy. Family Process 23(2), 177–185.Google Scholar
Yamazaki, F (1996) Dying in a Japanese hospital. Tokyo: Japan Times.Google Scholar
Zimmermann, C (2004) Denial of impending death: A discourse analysis of the palliative care literature. Social Science & Medicine 59(8), 1769–1780.Google Scholar