title: Palliative care communication: linking patients' prognoses, values, and goals of care.
abstract: Prognostic communication is a primary component of goals of care conversations in palliative care (PC) practice. Little is known about these conversations in the natural setting. This study's aim was to describe the processes of prognostic communication in PC goals of care consultations. Using line-by-line qualitative analysis, we examined prognostic conversation in 66 audio-taped PC consultations. We identified five processes by which clinicians link prognoses, values, and goals of care: (1) signposting the crossroads; (2) closing off a goal; (3) clarifying current path; (4) linking paths and patients' values; and (5) choosing among paths. The findings add to our understanding of PC consultation by describing how prognoses link with patients' values and choices in goals of care conversations.
authors.affiliation: School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642.
authors.forename: Sally A
authors.initials: SA
authors.lastname: Norton
authors.forename: Maureen
authors.initials: M
authors.lastname: Metzger
authors.forename: Jane
authors.initials: J
authors.lastname: DeLuca
authors.forename: Stewart C
authors.initials: SC
authors.lastname: Alexander
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Quill
authors.forename: Robert
authors.initials: R
authors.lastname: Gramling
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009723:Nurse-Patient Relations; D009936:Organizational Innovation; D010166:Palliative Care / Q000379:methods*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D011379:Prognosis; D036301:Qualitative Research; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D013637:Tape Recording
keywords: communication; end of life; goals of care; palliative care; prognosis; qualitative