Researchers Learn About End-Of-Life Communication

From the 4 June 2011 article at Medical News Today

…Lead author Robert E. Gramling, M.D., Sc.D., associate professor of Family Medicine at URMC, and colleagues with a special interest in palliative care, made several key discoveries:

• In 93 percent of the conversations, prognosis was brought up and discussed by at least one person, with the palliative care team broaching the issue 65 percent of the time. Also, the prognosis information focused more often on quality of life rather than survival, and on the unique individual rather than the population in general. Researchers noted that prior studies support the link between open and honest discussions about prognosis to clinical benefits.
• Both patients/families and physicians/nurses on the palliative care team tended to frame prognosis with more pessimism than optimism. This was unexpected and different than the usual patterns of communication, where talk of a serious illness tends toward avoidance or unbalanced optimism, researchers said. However, emphasizing accuracy during the palliative care consultation usually leads to treatment decisions that match patient preferences.
• The substance and tone of the conversations varied, depending on whether the patient was present and actively participating. For example, prognosis conversations with family members alone were more pessimistic and contained more explicit information. It is possible, researchers said, this type of conversation takes place out of respect for the patient, who might be sicker in this scenario, or is someone who prefers to avoid information.
• The closer to death, the more likely the palliative care physician was to foretell or forecast events. This might seem logical – that doctors would guide patients and families in what to expect as death approached – but in reality this vulnerable and frightening time is when families often report a void in communication. The URMC data suggests that palliative care consultations respond to this need….

Related articles

• Listening in, researchers learn about end-of-life communication (eurekalert.org)
• Palliative Care in Australia (blogs.abc.net.au)
• Some Facts On Palliative Care (georgevanantwerp.com)
• A nurse practitioner-driven palliative care intervention improves cancer patients’ quality of life (eurekalert.org)
• Honest talk eases end-of-life choices (futurity.org)
• A nurse practitioner-driven palliative care intervention improves cancer patients’ quality of life (medicalxpress.com)
• Nurses urged to discuss death with heart patients (yorkshirepost.co.uk)
• Improving Palliative Care For Heart Failure Patients (medicalnewstoday.com)