Many deaths in Norway occur in medical wards organized to provide curative treatment. Still, medical departments are obliged to meet the needs of patients at the end of life. Here, we analyse the electronic patient record regarding documentation of the transition from curative to palliative care (i.e. the ‘turning point’). Considering the consequences of these decisions for patients, they have received surprisingly little attention from researchers. This study aims to investigate how the patient record denotes reasons for the shift from curative treatment to palliation and how texts involve voices of the patient and their families. The study comprised excerpts from electronic patient records retrieved from medical wards in three urban hospitals in Norway. We executed a retrospective analysis of anonymized extracts from 16 electronic patient records, searching for documentation on the transition from curative to palliative care. In the development of the turning point, the texts usually shift from statements about the patient’s clinical status and technical findings to displaying uncertainty and openness to negotiation with different textual voices. This shift may represent a need to align or harmonize the attitudes of colleagues, family, and patient towards the turning-point decision. The patient’s voice is mostly absent or reported only briefly when, in their notes, nurses gave an account of the patient’s opinion. None of the physicians’ notes provided a detailed account of patient attitudes, wishes, and experiences. In this article, we have analysed textual representations of patient transitions from curative to end-of-life care. The ‘reality’ behind the text has not been our concern. As the only documentation left, the patient record is an adequate basis for considering how patients are estimated and cared for in their last days of life.

中文翻译：

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谈判从治愈到姑息治疗的转折点：垂死患者医疗记录的语言分析。

在挪威，许多死亡发生在组织提供治疗的医疗病房中。尽管如此，医疗部门仍有义务在生命的尽头满足患者的需求。在这里，我们分析了有关从治疗到姑息治疗过渡（即“转折点”）的文档的电子病历。考虑到这些决定对患者的影响，研究人员很少关注他们。这项研究旨在调查患者病历如何表示从治愈性治疗过渡到姑息治疗的原因，以及文本如何涉及患者及其家人的声音。这项研究包括从挪威三所城市医院的病房中检索到的电子病历摘录。我们对16份电子病历中的匿名摘录进行了回顾性分析，以寻找有关从治愈到姑息治疗过渡的文献资料。在转折的发展过程中，案文通常从关于患者临床状况和技术发现的陈述转变为表现出不确定性和开放性，以不同的文本声音进行谈判。这种转变可能表示需要调整或协调同事，家人和患者对转折点决策的态度。当护士在笔记中记述了患者的意见时，几乎没有患者的声音或只是短暂地报告了患者的声音。没有任何医生的笔记详细说明患者的态度，愿望和经历。在这篇文章中，我们分析了患者从治疗到临终护理过渡的文字表现形式。案文背后的“现实”并不是我们所关注的。作为唯一的记录，患者记录是考虑患者生命的最后阶段时如何评估和护理患者的充分依据。