Sorry for the delay in posting, was having CLE access issues. Thanks in advance for comments!
Laura
This is an incredibly interesting topic. I agree, I would worry about trying to dive into this potentially very deep topic at the end of an already emotionally-charged interview. The flip side is that I can see a logical flow to the conversation which hopefully will make it work - how do you like to talk about prognosis, and how do you like to talk about death/dying? I would start with a more open-ended question about experiences talking to your doctor about death, and if no experience, if he/she would like to talk to his/her provider. Then I'd get into your specific questions. I'm not totally clear from your background section why you jump directly to physician aid-in-dying questions as opposed to starting with patient preferences/experiences about those conversations, but I'm assuming that's because there is more background literature pointing you to go directly into those topics.
Regarding subjects, I'm guessing that the reason you are interviewing the patients you describe is due to feasibility. That's completely reasonable, but you may need to acknowledge in your discussion that individuals in care/presenting to a healthcare visit may have different levels of trust in providers/comfort talking about death than those who are not in care. Another way to get at this topic would be to recruit older adults at senior centers, church, etc., trying to reach older adults less connected to the healthcare system who may have different levels of trust. In addition, I don't know what the SES diversity is like at UCSF, but it might be interesting (with more time, more $$) to include SFGH patients as well. Finally, I wonder if patients might be more comfortable talking about their interactions with providers at home (aka outside of the clinic) rather than in the clinic where they might feel pressured to speak more highly of their doctors. This is a more minor point, but it might be interesting as you go along to see if the interview feels more "open" in one location or another.
I'm excited to hear about your findings!
-Nika
Very cool topic. You have a really fascinating "hypothesis" or hunch about how folks might respond to this issue. So I like the idea of approaching this with a deductive strategy. At the same time, what you're investigating are pretty abstract issues: "trust" and "physician aid-in-dying" are fairly subtle principles and behaviors. So you may want to think about how you can make these issues more concrete for respondents...especially if your initial questions aren't productive. It even could be hard to ask whether the respondent has a friend/relative who had a "bad death" -- especially with this group of respondents given your hypothesis. So you may want to approach this as if you were doing a more grounded theory analysis. Get folks talking in general about end of life care or situations where someone died in the hospital. And see if issues of trust emerge or if there are comments about how the doctors provided care -- then probe probe probe to try to get further information on these particular issues of interest.
This is a fascinating topic made more important by California's passage of a physician assisted suicide law. Given that this is such a sensitive topic it may be worth conducting longer "test" interviews with subjects from this population prior to conducted your main interviews. Another possibility if this is not feasible is to at least talk to people in Chinese, African-American, and Hispanic communities (even if it just other healthcare providers with these cultural backgrounds) about how these issues are viewed and talked about in the community. This may help you avoid any unintended cultural faux pas during the actual interviews. It may also help guide the questions you ask early interviews since you have a limited time in which to address this topic.