Addressing possible problems with patients’ expectations, plans and decisions for the future: one strategy used by experienced clinicians in advance care planning conversations
journal contributionposted on 22.11.2018, 13:44 by Victoria Land, Ruth Parry, Marco Pino, Laura Jenkins, Luke Feathers, Christina Faull
Objective Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients’ expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients’ expectations, plans or decisions. Methods Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions. Results Eleven episodes involving five doctors were found. In all of these we identified a ‘Hypothetical Scenario Sequence’ where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients’ expectations and plans. Conclusion Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients’ preferences whilst preparing them for possible difficulties and inevitable uncertainties. Practice Implications Where professionals judge it appropriate to raise problems about patients’ preferences, plans and decisions, this sequence can manage the associated risks
This research was supported in its initial stages by the University of Nottingham, including via a Research Development Fund grant from the University of Nottingham Centre for Advanced Studies; the bulk of the work was funded by The Health Foundation. The project: “VERDIS: Video-based communication research and training in supportive and palliative care” forms part of the Health Foundation’s Insight programme. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK. The Health Foundation funded open access publication for this paper. From October 2015 Ruth Parry’s work, including in finalising this report, was supported by National Institute for Health Research Career Development Fellowship award CDF-2014-07-046 “Enhancing staff-patient communication in palliative and end of life care. This report presents independent research partially funded by the National Institute for Health Research (NIHR).
- Social Sciences
- Communication, Media, Social and Policy Studies