The presence of supportive family members was expressed as allowing specialists
to remain to some degree removed from the emotion work inherent in
patient and family dynamics. That is, they reported delegating or deflecting
decision-making about palliative and end-of-life care from a doctor–patient–
family conversation to an intra-familial discussion. In this way, the specialists
found conversations with the patient about referral in the presence of families
to be more straightforward. The emotional reactions of patients and family
members associated with the acceptance of death and dying were viewed as largely
taking place away from the specialist’s office, usually at home before or
after an appointment. There was frequent talk within the interviews of patient
and family stoicism during discussions of referral to specialist palliative care
with the specialist. Moreover, some specialists speculated about family relationships
and processes away from their office: