title: Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying.
abstract: OBJECTIVE
  To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of "eliciting and responding to cues", which has been widely advocated in the EoL care literature, promotes EoL talk.
  
  
  METHODS
  Conversation analysis of video- and audio-recorded consultations.
  
  
  METHODS
  Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors.
  
  
  METHODS
  Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.
  
  
  RESULTS
  Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce-then later further articulate-EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients' talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as "cues" as is common in EoL communication contexts. We examine these limitations and propose "possible EoL considerations" as a descriptively more accurate term.
  
  
  CONCLUSIONS
  Through communicating-via open elaboration solicitations-in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
authors.affiliation: Department of Social Sciences, Loughborough University, Loughborough, United Kingdom.
authors.forename: Marco
authors.identifier: http://orcid.org/0000-0003-1571-5028
authors.initials: M
authors.lastname: Pino
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Ruth
authors.initials: R
authors.lastname: Parry
authors.affiliation: School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Land
authors.affiliation: LOROS hospice, Leicester, United Kingdom.
authors.forename: Christina
authors.initials: C
authors.lastname: Faull
authors.affiliation: LOROS hospice, Leicester, United Kingdom.
authors.forename: Luke
authors.initials: L
authors.lastname: Feathers
authors.affiliation: School of Nursing and Midwifery, The University of Sheffield, Sheffield, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Seymour
mesh_terms: D001293:Attitude to Death; D005260:Female; D058015:Health Communication / Q000379:methods*; D017051:Hospice Care / Q000379:methods; D006801:Humans; D008297:Male; D065126:Palliative Medicine / Q000379:methods*; D010817:Physician-Patient Relations; D010820:Physicians; D019452:Terminally Ill / Q000523:psychology*