Managing uncertainty and references to time in prognostic conversations with family members at the end of life: A conversation analytic study

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Manage episode 265324237 series 1316808
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This episode features Rebecca Anderson (Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK). Honest prognostic communication with families of patients in the final hours and days of life is important for enabling a good death and for families’ preparedness for that death. Prognostic uncertainty makes this communication challenging for clinicians and families. Clinicians provided what we term ‘absolute categorical time estimates’ (suggesting a prognosis of ‘hours’ or ‘days’) and explained how that prognosis was reached, allowing them to reduce prognostic uncertainty without committing to an overly specific timescale. When requesting prognostic information, relatives helped to relieve the burden of uncertainty for clinicians by alluding to their awareness that prognostication is a subjective judgement. Clinicians and relatives could be direct about prognosis without explicitly referring to ‘death’ and ‘dying’, as references to time were understood by both parties as referring to prognosis. This paper identified key practices for communicating prognosis with families of patients at the very end of life, such as explicitly stating the uncertainty while invoking expertise, and using absolute categorical time estimates when providing a prognosis. These practices could be taught as part of communication training using clips of recordings from real-life interactions. Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216320910934 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: a.nwosu@lancaster.ac.uk

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