title: Directly observed patient-physician discussions in palliative and end-of-life care: a systematic review of the literature.
abstract: OBJECTIVE
  To review studies that used direct observation (i.e., videotaping or audiotaping) methods in palliative/end-of-life care communication research.
  
  
  METHODS
  Descriptive thematic analysis.
  
  
  METHODS
  Multinational studies were conducted in both the outpatient and inpatient setting.
  
  
  METHODS
  Extensive bibliographic searches (January 1, 1998 to July 31, 2009) of English-language literature involving physician-patient (or physician-family) interactions were conducted and augmented by reviews of reference listings. Three investigators independently abstracted key information from each article.
  
  
  RESULTS
  Of the 20 retained articles, most enrolled young-old participants (mean age, 60 years) who were white and had a cancer diagnosis. Patient/family participation rates ranged from 68% to 89% demonstrating feasibility of this approach when studying palliative/end-of-life care communication issues. Four common themes were identified: (1) physicians focus on medical/technical and avoid emotional/quality of life issues; (2) sensitive topics are perceived by physicians to take longer to discuss and often do take longer to discuss; (3) physicians dominate discussions; and (4) patient/family satisfaction is associated with supportive physician behaviors.
  
  
  CONCLUSIONS
  This study demonstrates that direct observation methods can be feasibly used when studying physician-patient/physician-family communication in palliative/end-of-life care, but few investigations have utilized this approach. This article highlights areas that need improvement, including physicians' ability to address patient/family emotional issues and provide what patients and families find most satisfying (participation and support). A particular focus on older patients and patients with end-stage or late-stage chronic (noncancer) illness, the adaptation/application of existing communication measurement tools to capture palliative care communication issues, and development of corresponding outcome measures to assess impact is now needed.
authors.affiliation: Department of Geriatrics, Center for Geriatrics, University Hospitals, Case Medical Center, Cleveland, Ohio 44106, USA. Elizabeth.Fine@uhhospitals.org
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fine
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
authors.forename: Rouzi
authors.initials: R
authors.lastname: Shengelia
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Adelman
mesh_terms: D002755:Choice Behavior; D003142:Communication; D006738:Hospices; D006801:Humans; D010166:Palliative Care; D010817:Physician-Patient Relations