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12-06-2012 | Legal medicine | Article

Clinicians communicate prognosis at end of life

Abstract

Free abstract

MedWire News: Prognosis is frequently discussed in the palliative care setting, with the presence of family members and a short expected survival affecting the rate of such discussions, report researchers.

The findings emerge from analysis of a set of audio recordings taken during 71 palliative care consultations between physicians and patients and their families.

"Good communication might be the single most important element of palliative care," said Robert Gramling (University of Rochester, New York, USA) in a press statement regarding the research.

"Through direct observation we have demonstrated how these talks occur and the important dimension they add at the end of life," he added.

The results, published in the Journal of Pain and Symptom Management, show that the issue of prognosis was raised in almost all of the consultations recorded, and that participants framed prognosis information using more pessimistic than optimistic cues.

It also revealed that conversations involving patients' families and not the patients themselves contained more, and often more frequently pessimistic, prognosis cues, and that the pattern of prognosis communication increased in intensity and pessimism closer to the physician-predicted time of death.

Specifically, 93% of consultations contained at least one speaker-turn that included prognosis information, and 53% contained speech about prognosis by both patients (or their families) and the palliative care team.

Prognosis information centered on quality of life more often than overall survival, with a mean difference of 3.3 counts per consultation, report Gramling et al.

Furthermore, conversations were more often focused on the individual than the population and contained more pessimistic than optimistic cues, with respective differences in count of 3.8 and 0.8.

"This is different than the usual pattern of prognosis communication in serious illness that tends toward avoidance or unbalanced optimism," writes the team.

After controlling for factors including patient age and functional status, the rate of prognosis information increased with the proximity of death, from a mean 7.2 counts per hour when the physician anticipated the patient had more than 2 weeks left to live, to 13.1 counts with 2 weeks to 24 hours left to live, and 21.2 counts with less than 24 hours remaining.

"When patients and families clearly understand the road ahead they can make the best decisions, based on their own values, desires, and goals," concluded Gramling.

By Sarah Guy

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