Engaging terminally ill patients in end of life talk: how experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying

Pino, Marco; Parry, Ruth; Land, Victoria; Faull, Christina; Feathers, Luke; Seymour, Jane

Abstract

Objective:
To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk.

Design:
Conversation analysis of video- and audio-recorded consultations.

Participants:
Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors.

Setting:
Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.

Results:
Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce Ð then later further articulate Ð EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk.
There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term.

Conclusions:
Through communicating Ð via open elaboration solicitations Ð in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.

Citation

Pino, M., Parry, R., Land, V., Faull, C., Feathers, L., & Seymour, J. (2016). Engaging terminally ill patients in end of life talk: how experienced palliative medicine doctors navigate the dilemma of promoting discussions about dying. PLoS ONE, 11(5), Article e0156174. https://doi.org/10.1371/journal.pone.0156174

• Journal Article Type: Article
• Acceptance Date: May 17, 2016
• Online Publication Date: May 31, 2016
• Publication Date: May 31, 2016
• Deposit Date: May 27, 2016
• Publicly Available Date: May 31, 2016
• Journal: PLoS ONE
• Electronic ISSN: 1932-6203
• Publisher: Public Library of Science
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 5
• Article Number: e0156174
• DOI: https://doi.org/10.1371/journal.pone.0156174
• Public URL: https://nottingham-repository.worktribe.com/output/787791
• Publisher URL: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156174
• Contract Date: May 27, 2016