Marco Pino1, Ruth Parry2. 1. Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK. Electronic address: M.Pino@lboro.ac.uk. 2. Department of Social Sciences, Loughborough University, Brockington Building, Margaret Keay Rd, Loughborough, Leicestershire, LE11 3TU, UK. Electronic address: R.Parry@lboro.ac.uk.
Abstract
OBJECTIVE: To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so. METHODS: Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists. RESULTS: Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work. CONCLUSION: Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates. PRACTICE IMPLICATIONS: Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.
OBJECTIVE: To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so. METHODS: Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists. RESULTS: Life-expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients' companions also contribute to this preparatory work. CONCLUSION: Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates. PRACTICE IMPLICATIONS: Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.
Authors: Stuart Ekberg; Ruth Parry; Victoria Land; Katie Ekberg; Marco Pino; Charles Antaki; Laura Jenkins; Becky Whittaker Journal: BMC Palliat Care Date: 2021-12-08 Impact factor: 3.234
Authors: An Tran-Duy; Josh Knight; Philip M Clarke; Ann-Marie Svensson; Björn Eliasson; Andrew J Palmer Journal: Diabetologia Date: 2021-07-26 Impact factor: 10.122