BACKGROUND: Prognosis conversations are complex phenomena of substantial importance to palliative care (PC), yet these remain poorly understood. This study empirically identifies and describes major types of prognosis conversations that occur in the natural setting of PC consultation. METHODS: We audio-recorded and coded 71 inpatient "goals of care" PC consultations at a large academic medical center in the northeastern United States. We used quantitative Latent Class Analyses for identifying discrete prognosis conversation types and qualitative Dimensional Analyses for more fully describing the process and content of the latent classes. RESULTS AND CONCLUSIONS: We observed three discrete types of prognosis conversations, each placing different communication demands upon all participants for achieving goal-concordant care: Navigating Options & Goals (56% of consultations), Facilitating New Goals (23%) and Preparing for End-of-Life (21%). This study provides the first step for developing educational and clinical prognosis communication interventions that are tailored to common decision-making contexts facing seriously ill patients, their families, and PC clinicians.
BACKGROUND: Prognosis conversations are complex phenomena of substantial importance to palliative care (PC), yet these remain poorly understood. This study empirically identifies and describes major types of prognosis conversations that occur in the natural setting of PC consultation. METHODS: We audio-recorded and coded 71 inpatient "goals of care" PC consultations at a large academic medical center in the northeastern United States. We used quantitative Latent Class Analyses for identifying discrete prognosis conversation types and qualitative Dimensional Analyses for more fully describing the process and content of the latent classes. RESULTS AND CONCLUSIONS: We observed three discrete types of prognosis conversations, each placing different communication demands upon all participants for achieving goal-concordant care: Navigating Options & Goals (56% of consultations), Facilitating New Goals (23%) and Preparing for End-of-Life (21%). This study provides the first step for developing educational and clinical prognosis communication interventions that are tailored to common decision-making contexts facing seriously ill patients, their families, and PC clinicians.
Authors: James A Tulsky; Robert M Arnold; Stewart C Alexander; Maren K Olsen; Amy S Jeffreys; Keri L Rodriguez; Celette Sugg Skinner; David Farrell; Amy P Abernethy; Kathryn I Pollak Journal: Ann Intern Med Date: 2011-11-01 Impact factor: 25.391
Authors: Jennifer S Temel; Joseph A Greer; Sonal Admane; Emily R Gallagher; Vicki A Jackson; Thomas J Lynch; Inga T Lennes; Connie M Dahlin; William F Pirl Journal: J Clin Oncol Date: 2011-05-09 Impact factor: 44.544
Authors: Stewart C Alexander; Kathryn I Pollak; Perri A Morgan; Justine Strand; Amy P Abernethy; Amy S Jeffreys; Robert M Arnold; Maren Olsen; Keri L Rodriguez; Sarah K Garrigues; Justin R E Manusov; James A Tulsky Journal: Support Care Cancer Date: 2010-09-04 Impact factor: 3.603
Authors: Richard Brown; Carma L Bylund; Julia Eddington; Jennifer A Gueguen; David W Kissane Journal: Psychooncology Date: 2010-04 Impact factor: 3.894
Authors: Tracy M Robinson; Stewart C Alexander; Margie Hays; Amy S Jeffreys; Maren K Olsen; Keri L Rodriguez; Kathryn I Pollak; Amy P Abernethy; Robert Arnold; James A Tulsky Journal: Support Care Cancer Date: 2008-01-15 Impact factor: 3.603
Authors: Christy E Cauley; Susan D Block; Luca A Koritsanszky; Jonathon D Gass; Julia L Frydman; Suliat M Nurudeen; Rachelle E Bernacki; Zara Cooper Journal: J Palliat Med Date: 2016-04-22 Impact factor: 2.947
Authors: Rebecca N Hutchinson; Eric C Anderson; Mollie A Ruben; Noah Manning; Liam John; Ava Daruvala; Donna M Rizzo; Margaret J Eppstein; Robert Gramling; Paul K J Han Journal: J Palliat Med Date: 2022-04-12 Impact factor: 2.947
Authors: Robert Gramling; Kevin Fiscella; Guibo Xing; Michael Hoerger; Paul Duberstein; Sandy Plumb; Supriya Mohile; Joshua J Fenton; Daniel J Tancredi; Richard L Kravitz; Ronald M Epstein Journal: JAMA Oncol Date: 2016-11-01 Impact factor: 31.777
Authors: Eline van den Broek-Altenburg; Robert Gramling; Kelly Gothard; Maarten Kroesen; Caspar Chorus Journal: BMC Palliat Care Date: 2021-01-25 Impact factor: 3.234
Authors: Robert Gramling; Elizabeth Gajary-Coots; Susan Stanek; Nathalie Dougoud; Heather Pyke; Marie Thomas; Jenica Cimino; Mechelle Sanders; Stewart C Alexander; Ronald Epstein; Kevin Fiscella; David Gramling; Susan Ladwig; Wendy Anderson; Stephen Pantilat; Sally A Norton Journal: BMC Palliat Care Date: 2015-08-19 Impact factor: 3.234