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Collusion in palliative care: an exploratory study with the Collusion Classification Grid

  • Friedrich Stiefel (a1), Kenji Nakamura (a2), Kunihiko Ishitani (a2), Céline Bourquin (a1) and Michael Saraga (a1)...



Collusion is a largely unconscious, dynamic bond, which may occur between patients and clinicians, between patients and family members, or between different health professionals. It is widely prevalent in the palliative care setting and provokes intense emotions, unreflective behavior, and negative impact on care. However, research on collusion is limited due to a lack of conceptual clarity and robust instruments to investigate this complex phenomenon. We have therefore developed the Collusion Classification Grid (CCG), which we aimed to evaluate with regard to its potential utility to analyze instances of collusion, be it for the purpose of supervision in the clinical setting or research.


Situations of difficult interactions with patients with advanced disease (N = 10), presented by clinicians in supervision with a liaison psychiatrist were retrospectively analyzed by means of the CCG.


1) All items constituting the grid were mobilized at least once; 2) one new item had to be added; and 3) the CCG identified different types of collusion.

Significance of results

This case series of collusions assessed with the CCG is a first step before the investigation of larger samples with the CCG. Such studies could search and identify setting-dependent and recurrent types of collusions, and patterns emerging between the items of the CCG. A better grasp of collusion could ultimately lead to a better understanding of the impact of collusion on the patient encounter and clinical decision-making.


Corresponding author

Author for correspondence: Friedrich Stiefel, Psychiatric Liaison Service, Lausanne University Hospital and University of Lausanne, Les Allières, Av. de Beaumont 23, 1011 Lausanne, Switzerland. Email:


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Collusion in palliative care: an exploratory study with the Collusion Classification Grid

  • Friedrich Stiefel (a1), Kenji Nakamura (a2), Kunihiko Ishitani (a2), Céline Bourquin (a1) and Michael Saraga (a1)...


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