<i>'It showed me that he sensed I was there. . .'</i>, The 'relational' use of an electrophysiological tool for evaluating the level of discomfort of people at the end of life: A reflexive thematic analysis.

Abstract

The Analgesia Nociception Index device may serve as a guide to a person's parasympathetic activity via the heart rate variability. It is used to assess the level of discomfort of non-communicative patients at the end of life. Although the index's acceptability in palliative care have been demonstrated, the healthcare professionals and the patient's relatives did not have direct, continuous access to the monitor screen. To evaluate how healthcare professionals and patients' relatives in a palliative care unit perceived the use of the Analgesia Nociception Index. A qualitative, comprehensive, two-centre study was based on individual, semidirective interviews. The interview data were evaluated in a reflexive, thematic analysis. We interviewed (i) healthcare professionals who used the Analgesia Nociception Index in their routine practice and (ii) the relatives of patients who had been monitored with the tool during their stay in the unit. A total of 28 interviews were conducted. The device was perceived mainly to be an additional medical technique for increasing a person's level of comfort. Some professionals highlighted a risk of re-medicalizing the end of life, with a display screen that distracted attention from the person. A few relatives stated that the changes on the screen were a way of staying in touch with their loved one's perception. The tool helped to increase the value of the relatives' support. The present results might help clinicians to tailor the monitoring to each patient's situation and to communicate more effectively with both care teams and relatives.