'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication. Issue 10 (8th October 2014)

• Record Type: Journal Article
• Authors: Abdul-Razzak, Amane; You, John; Sherifali, Diana; Simon, Jessica; Brazil, Kevin
• Is Part Of: BMJ open. Volume 4:Issue 10(2014)
• Publication Date: 2014-10-08
• Subjects: end-of-life communication -- advance care planning -- patient preference -- physician-patient relations -- critical illness; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2014-005653
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objective: To understand patients' preferences for physician behaviours during end-of-life communication. Methods: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6–12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer). Results: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information. Conclusions: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.