Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Anderson, Rebecca J.; Stone, Patrick C.; Low, Joseph T.S.; Bloch, Steven
• Is Part Of: Patient education and counseling. Volume 104:Issue 5(2021)
• Page Start: 1075
• Page End: 1085
• Publication Date: 2021-05
• Subjects: Communication -- Conversation analysis -- End of life -- Palliative care -- Hospice -- Uncertainty -- Prognosis; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2020.10.009
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Clinicians and families gradually transition away from uncertain prognostic talk. Clinicians do so by describing steps to ensure patient comfort and family wellbeing. Clinicians address families' concerns and then pivot towards action-oriented talk. These practices highlight the continued care of patients and families. Abstract: Objective: To examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients. Methods: Conversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice. Results: Following the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort. Conclusion: In conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care. Practice Implications: In a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.