Parry Land Seymour 2014 how to communicate about future.pdf (653.74 kB)
How to communicate with patients about future illness progression and end of life: a systematic review
journal contribution
posted on 2018-04-23, 09:18 authored by Ruth Parry, Victoria Land, Jane SeymourBackground: Conversation and discourse analytic research has yielded important evidence about skills needed for effective, sensitive communication with patients about illness progression and end of life. Objectives To: Locate and synthesise observational evidence about how people communicate about sensitive future matters; Inform practice and policy on how to provide opportunities for talk about these matters; Identify evidence gaps. Design: Systematic review of conversation/ discourse analytic studies of recorded interactions in English, using a bespoke appraisal approach and aggregative synthesis. Results: 19 publications met the inclusion criteria. We summarised findings in terms of eight practices: 'fishing questions'-open questions seeking patients' perspectives (5/19); indirect references to difficult topics (6/19); linking to what a patient has already said-or noticeably not said (7/19); hypothetical questions (12/19); framing difficult matters as universal or general (4/19); conveying sensitivity via means other than words, for example, hesitancy, touch (4/19); encouraging further talk using means other than words, for example, long silences (2/19); and steering talk from difficult/negative to more optimistic aspects (3/19). Conclusions: Practices vary in how strongly they encourage patients to engage in talk about matters such as illness progression and dying. Fishing questions and indirect talk make it particularly easy to avoid engaging-this may be appropriate in some circumstances. Hypothetical questions are more effective in encouraging ontopic talk, as is linking questions to patients' cues. Shifting towards more 'optimistic' aspects helps maintain hope but closes off further talk about difficulties: practitioners may want to delay doing so. There are substantial gaps in evidence.
Funding
The study was funded by the Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care at the School of Health Sciences, University of Nottingham (for RP's and JS's time) and by a small grant from the School of Health Sciences, University of Nottingham (for VL's time). The study sponsor was the University of Nottingham.
History
School
- Social Sciences
Department
- Communication, Media, Social and Policy Studies
Published in
BMJ Supportive and Palliative CareVolume
4Issue
4Pages
331 - 341Citation
PARRY, R., LAND, V. and SEYMOUR, J., 2014. How to communicate with patients about future illness progression and end of life: a systematic review. BMJ Supportive and Palliative Care, 4 (4), pp.331-341.Publisher
BMJ Publishing GroupVersion
- VoR (Version of Record)
Publisher statement
This work is made available according to the conditions of the Creative Commons Attribution-NonCommercial 3.0 Unported (CC BY-NC 3.0) licence. Full details of this licence are available at: http://creativecommons.org/licenses/by-nc/3.0/Publication date
2014Notes
This is an Open Access Article. It is published by BMJ Publishing Group under the Creative Commons Attribution-NonCommercial 3.0 Unported Licence (CC BY-NC). Full details of this licence are available at: http://creativecommons.org/licenses/by-nc/3.0/ISSN
2045-435XeISSN
2045-4368Publisher version
Language
- en