How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice Marco Pino Ruth Parry 2134/32603 https://repository.lboro.ac.uk/articles/journal_contribution/How_and_when_do_patients_request_life-expectancy_estimates_Evidence_from_hospice_medical_consultations_and_insights_for_practice/9471824 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. 2018-04-16 15:11:06 Conversation analysis End of life Hospice Life expectancy Palliative medicine Prognosis Requests Uncertainty Language, Communication and Culture not elsewhere classified Studies in Human Society not elsewhere classified