Shifting perspectives in palliative and end-of-life care: a personal view

Community nurses work closely with patients and families as the end of life approaches. Many patients, as well as their families and friends, may come to realise that the end of their life is getting closer with each time their illness deteriorates. With this realisation comes the painful decision to abandon unrealistic pursuits and concentrate on what seems possible within the restrictions imposed by their illness. The pain comes from being torn between continuing with life but knowing this is no longer an option under their control and refocusing on other elements of their remaining life. In this moment, many people rearrange and reprioritise the various aspects of their life, which Gawande (2015) referred to as ‘shifting their perspectives’.

Gawande suggested that people engage in a shift of perspectives in response to how they perceive how much time they have left. Patients and relatives are often heard asking doctors and nurses: ‘how long have I got?’ or ‘am I dying?’. Very often, healthcare professionals misconstrue these as difficult questions, but when they are understood correctly, the realisation occurs that perspectives matter, and the responses provided often influence a shift in the questioner's future outlook.