Direct observation of prognosis communication in palliative care: a descriptive study.
BACKGROUND
Palliative care (PC) consultations result in improved patient understanding of prognosis and better quality of life, yet the content and processes of prognosis communication during PC consultations remain unknown.


OBJECTIVE
To describe prognosis communication during PC consultation with seriously ill hospitalized patients.


METHODS
We audio recorded 71 sequential inpatient PC consultations (initial visit) with seriously ill patients and their families who were referred for "goals of care" clarification or help with "end-of-life decision making." Conversations were coded using reliable methods and we then linked conversation codes to clinical record and clinician interview data.


RESULTS
Ninety-three percent of consultations contained prognosis communication. Participants communicated prognoses regarding quality of life more frequently than survival; focused prognosis estimates on the unique patient more frequently than on a general population; and framed prognosis using pessimistic cues more frequently than optimistic ones. Prognoses were more commonly spoken by PC clinicians than by patients/families. The following two factors demonstrated an association with the rate of prognostic communication and with the pessimistic framing of that information: whether the patient, family, or both participated in the conversation, and shorter expected survival (as estimated by the attending physician).


CONCLUSIONS
Prognoses are routinely communicated in PC consultations with hospitalized patients and their families. The rate and characteristics of prognosis communication differ based on the length of time the patient is expected to live.
University of Rochester, Rochester, New York 14620, USA. Robert_Gramling@URMC.Rochester.edu
Robert
R
Gramling
Sally A
SA
Norton
Susan
S
Ladwig
Maureen
M
Metzger
Jane
J
DeLuca
David
D
Gramling
Daniel
D
Schatz
Ronald
R
Epstein
Timothy
T
Quill
Stewart
S
Alexander
D032722:Advance Care Planning / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D058015:Health Communication; D006801:Humans; D007258:Informed Consent / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D009518:New York / Q000453:epidemiology; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D010347:Patient Care Planning / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data*; D010358:Patient Participation; D010817:Physician-Patient Relations; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data