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Revisiting Awareness Contexts in the 21st Century Hospital

Sat, August 22, 4:30 to 6:10pm, TBA

Abstract

In 1965, Barney Glaser and Anselm Strauss published Awareness of Dying, the first of two scholarly books written by the authors on the topic of death in American hospitals. One of the most widely cited and discussed concepts to emerge from Glaser and Strauss’s work on death and dying is the concept of ‘awareness contexts,’ or the idea that terminally ill patients treated in hospitals are aware—to differing degrees—of their health status and impending deaths. In this paper, we explore how two related structural conditions—the increased specialization of medical providers and the fragmentation of patient care—directly affect the awareness contexts of patients. Based on interviews with 43 families of deceased patients and six months of observation in a midwestern hospital, we suggest that medical specialization and fragmented care impact how providers talk with patients and families about prognosis and, in turn, what patients and families understand about the severity of illness. Bringing structure “back in” in this way allows us to return to one of the central tenets of Glaser and Strauss’s theory: that the structural context of the hospital profoundly shapes provider-patient interaction at end of life.

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