12/21/2023 0 Comments Awareness contexts![]() Although Glaser and Strauss discuss each context in detail in Awareness of Dying (1965), subsequent research on awareness contexts tends to focus on open and closed awareness. In Glaser and Strauss's formulation, awareness contexts can be divided into four types: open awareness, closed awareness, suspicion awareness, and mutual pretense awareness. Based on interviews with 43 family members of deceased patients who died at General Hospital in the Midwestern US, we argue that two related conditions in hospitals-the increased specialization of medical professionals and the fragmentation of patient care-serve as important context for the death awareness of patients and families. This paper asks why, in an era of open awareness, are patients and families uncertain about dying? To answer this question, we focus on an aspect of Glaser and Strauss's theory that remains relatively understudied by researchers, namely the role of institutional and organizational realities in shaping awareness contexts. Despite the known benefits of open awareness, many terminal patients remain unaware or confused about their prognoses (Chen et al., 2017). While closed awareness was the norm in 1960s, open awareness is now considered standard practice in US, a reflection of mounting evidence that patients, families, and providers benefit from clear and honest communication at end of life (Seale et al., 1997 Wright et al., 2008). Awareness ranges from closed (where patients are completely unaware and family and providers protect “the secret”) to open (where all parties communicate openly and honestly). In 1965, Glaser and Strauss (1965) offered the concept of “awareness contexts” to explain what patients in hospitals do or don't know about their death trajectories.
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