Academic journal article The Qualitative Report

The Components of Attentiveness in Oncology Care

Academic journal article The Qualitative Report

The Components of Attentiveness in Oncology Care

Article excerpt

From a care ethical perspective care and attentiveness are internally connected. To promote good care, it is therefore essential to understand more of the hitherto poorly defined and little studied phenomenon of attention as an ethically relevant concept. Different authors have elaborated on the relationship between attentiveness and care (Conradi, 2001; Engster, 2005; Tronto, 2013), of which Tronto's analysis was the most influential. She distinguishes five phases of care, which are conceptually separate, but interconnected in practice. According to her, the first phase is caring about, which she links to the ethical element of attentiveness. Caring about implies that care is necessary. It means identifying a certain need and establishing that this need should be met. This will often involve assuming the position of another person or group in order to recognize the need. Attentiveness is described by Tronto as the quality of individuals to open up to the needs of others. This view is important, but it is too narrow. We argue in favour of a broader view, in which attentiveness is not only a first instrumental step in care, but also the core element of care and, as such, essential for the following steps as well and even a good in itself (Klaver & Baart, 2011a). Research into the experiences of care receivers suggests that they identify good care with recognition: care receivers value being seen (Van Heijst, 2011; Vosman & Baart, 2011; Wilken, 2010). Attentiveness can make a caregiver see what is at stake for someone and how they might be supported. This means that attentiveness and care are interrelated: without attentiveness good care cannot exist (Conradi, 2001; Tronto, 2013). This applies to oncology care in particular, where patients' diseases are often multi-causal and incurable, and complex and/or chronic or terminal. However, in studies on attentiveness in (oncology) care, attentiveness is in general addressed primitively, by equating it with empathy, concentration or proper treatment. It is regarded a bonus on the side, something that adds friendliness, empathy or humaneness to care that should essentially be technically competent (Klaver & Baart, 2011b). Care ethical studies though, do show that attentiveness, as an indispensable ingredient of attuning to the other relationally, belongs to the core business of health care (Vosman & Baart, 2011). Despite the crucial importance ascribed to it, however, care ethical literature does not show any empirical studies of attentiveness, which is the starting point for this study.

In order to be sensitive to the broad and complex workings of attentiveness in care, we have let ourselves be nourished by insights on attentiveness from philosophy and phenomenology, psychology, theology, spirituality, and literature and art theories (Klaver & Baart, 2011a). In this intradisciplinary view, in which the focus is care ethical (Klaver, Baart, & Van Elst, 2013), attentiveness can be understood as a social phenomenon that can exist between people. It is located at the intersection of attentiveness as a cognitive ability (Johnson & Proctor, 2004) and attentiveness is expressed as care or love (Conradi, 2001). Attentiveness can make the difference between an instrumental relationship between caregiver and receiver, and a relationship in which good care can be given. In the latter case, this can lead to what might be good for the patient and what the attentiveness should be focused on. In this relational perspective, attentiveness has two essential actors or actor groups: a giver (of attentiveness) and a receiver. Therefore, what is perceived as attentiveness by the caregiver may not always experienced like that by the patient (Tronto, 2013).

This article is based on a grounded theory study undertaken on a hospital oncology ward in the Netherlands. It describes how attentiveness appears in this particular care practice. In this article, we report the findings of this study by presenting a descriptive model of attentiveness. …

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