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Listening in, researchers learn about end-of-life communication
Date:5/31/2012

What is the best way to talk to someone about prognosis and quality of life when serious illness strikes? It turns out that no one had studied that question through direct observation, until the University of Rochester Medical Center audio-recorded 71 palliative care discussions.

The data is published online in the Journal of Pain and Symptom Management.

Lead author Robert E. Gramling, M.D., Sc.D., associate professor of Family Medicine at URMC, and colleagues with a special interest in palliative care, made several key discoveries:

  • In 93 percent of the conversations, prognosis was brought up and discussed by at least one person, with the palliative care team broaching the issue 65 percent of the time. Also, the prognosis information focused more often on quality of life rather than survival, and on the unique individual rather than the population in general. Researchers noted that prior studies support the link between open and honest discussions about prognosis to clinical benefits.

  • Both patients/families and physicians/nurses on the palliative care team tended to frame prognosis with more pessimism than optimism. This was unexpected and different than the usual patterns of communication, where talk of a serious illness tends toward avoidance or unbalanced optimism, researchers said. However, emphasizing accuracy during the palliative care consultation usually leads to treatment decisions that match patient preferences.

  • The substance and tone of the conversations varied, depending on whether the patient was present and actively participating. For example, prognosis conversations with family members alone were more pessimistic and contained more explicit information. It is possible, researchers said, this type of conversation takes place out of respect for the patient, who might be sicker in this scenario, or is someone who prefers to avoid information.

  • The closer to death, the more li
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Contact: Leslie Orr
Leslie_Orr@urmc.rochester.edu
University of Rochester Medical Center
Source:Eurekalert

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