title: Talking about sensitive topics during the advance care planning discussion: A peek into the black box.
abstract: OBJECTIVE
  Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor-patient interactions.
  
  
  METHODS
  Following a discourse-analysis approach, the study uses the concept of doctor and patient "voices" to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark.
  
  
  RESULTS
  Previous studies of directly observed patient-physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance.
  
  
  CONCLUSIONS
  Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.
authors.affiliation: Department of Oncology,Aarhus University Hospital,Aarhus,Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Andreassen
authors.affiliation: The Palliative Team,Aarhus University Hospital,Aarhus,Denmark.
authors.forename: Mette Asbjørn
authors.initials: MA
authors.lastname: Neergaard
authors.affiliation: Department of Public Health,Aarhus University Hospital,AarhusDenmark.
authors.forename: Trine
authors.initials: T
authors.lastname: Brogaard
authors.affiliation: Department of Oncology,Aarhus University Hospital,Aarhus,Denmark.
authors.forename: Marianne Hjorth
authors.initials: MH
authors.lastname: Skorstengaard
authors.affiliation: Department of Oncology,Aarhus University Hospital,Aarhus,Denmark.
authors.forename: Anders Bonde
authors.initials: AB
authors.lastname: Jensen
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D010817:Physician-Patient Relations; D010865:Pilot Projects
keywords: Advance care planning (ACP); Communication; Discourse analysis; Future care; Palliative care