How to communicate with patients about future illness progression and end of life: a systematic review

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Parry, Ruth, Land, Victoria and Seymour, Jane (2014) How to communicate with patients about future illness progression and end of life: a systematic review. BMJ Supportive and Palliative Care, 4 . pp. 331-341. ISSN 2045-4368

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Official URL: http://spcare.bmj.com/content/4/4/331.full.pdf+html?sid=68f2b08a-c00f-42e2-834f-74c32b4e2ea3

Abstract

Background: Conversation and discourse analytic research has yielded important evidence about skills needed for effective, sensitive communication with patients about illness progression and end of life.

Objectives To:

Locate and synthesise observational evidence about how people communicate about sensitive future matters;

Inform practice and policy on how to provide opportunities for talk about these matters;

Identify evidence gaps.

Design: Systematic review of conversation/ discourse analytic studies of recorded interactions in English, using a bespoke appraisal approach and aggregative synthesis.

Results: 19 publications met the inclusion criteria. We summarised findings in terms of eight practices: fishing questions - open questions seeking patients’ perspectives (5/19); indirect references to difficult topics (6/19); linking to what a patient has already said — or noticeably not said (7/19); hypothetical questions (12/19); framing difficult matters as universal or general (4/19); conveying sensitivity via means other than words, for example, hesitancy, touch (4/19); encouraging further talk using means other than words, for example, long silences (2/19); and steering talk from difficult/negative to more optimistic aspects (3/19).

Conclusions: Practices vary in how strongly they encourage patients to engage in talk about matters such as illness progression and dying. Fishing questions and indirect talk make it particularly easy to avoid engaging — this may be appropriate in some circumstances. Hypothetical questions are more effective in encouraging on- topic talk, as is linking questions to patients’ cues. Shifting towards more ‘optimistic’ aspects helps maintain hope but closes off further talk about difficulties: practitioners may want to delay doing so. There are substantial gaps in evidence.

Item Type:

Article

RIS ID:

https://nottingham-repository.worktribe.com/output/737678

Keywords:

Communication, Healthcare Communication, Language and Social Interaction, Palliative Care, Terminal Illness, Healthcare Professionals, Patients, Death

Schools/Departments:

University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Health Sciences

Identification Number:

https://doi.org/10.1136/bmjspcare-2014-000649

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