Abstract
Background
Despite the proven benefits of early palliative care and national initiatives to increase access, patient communication regarding these services remains elusive. Many theories in the fields of health communication, psychology, and medicine offer valuable insights for early palliative care and uncertainty communication. While these various fields study communication and have developed communication theories, the discipline of nursing must also recognize and research its unique communicatory role. Therefore, this paper aims to a) provide a comprehensive literature review on nurse palliative care communication addressing chronic uncertainty in life-limiting illness, b) define the Reconceptualization of Uncertainty in illness Theory (RUIT) and Problematic Integration Theory (PIT) within a nursing Unitary Caring Science (UCS) worldview and, c) synthesize these theories and literature review into a unique conceptual framework for early palliative care communication in nursing.
Method
Turner’s theory synthesis methodology was combined with a comprehensive PRISMA literature review to produce an overarching framework that transcends and interprets existing theories. The literature search was conducted in July of 2023 and updated in May 2024 using Pubmed, PsychINFO, and EBSCOhost databases. A second literature search was undertaken to identify applicable uncertainty theories in chronic or LLIs. This theory-oriented search used health communication and nursing theory textbooks, reference chaining from our first comprehensive literature review, and keyword searches of applicable theories in Pubmed, PsychINFO, and EBSCOhost databases.
Results
This theory synthesis highlights the integrality of all facets of uncertainty for those living with severe life-limiting illnesses (personal factors, types of uncertainty, and the nursing communicatory process) and conceptualizes uncertainty communication as a series of events happening simultaneously, not simply a cause-and-effect process.
Discussion
The framework resulting from this synthesis encourages nurses' holistic understanding of the complex nature of uncertainty in life-limiting illness, highlights the integral communicatory role nurses have in their patients’ health and wellness, and promotes further nursing-specific communication research. Future implementation nursing research focusing on enabling nurse-initiated early palliative care communication will support patients' values and dignity throughout more than a single hospital stay but their entire disease trajectory.