How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice
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.
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; later stages of work were funded by The Health Foundation via an Insight grant RU33. The Health Foundation funded open access publication for this paper. From October 2015 onwards, R.P.’s work, including in finalising this report, was supported by National Institute for Health Research Career Development Fellowship award CDF-2014-07-046. This report presents independent research partially funded by the National Institute for Health Research (NIHR).
- Social Sciences
- Communication, Media, Social and Policy Studies