"Good communication might be the single most important element of palliative care," Gramling said, "and through direct observation we have demonstrated how these talks occur and the important dimension they add at the end of life."
The study took place at Strong Memorial Hospital at URMC, which has an in-patient hospice unit and provides more than 1,000 palliative care consultations annually at the hospital. With prior consent from all study participants, researchers placed high-definition digital recorders in unobtrusive locations in hospital rooms before the prognosis discussions took place.
Afterward, researchers coded the conversations based on whom was speaking, the topic, and how the information was framed, and then analyzed the data.
Examples of statements coded for prognosis: "It is unlikely that you will live for more than a month."Also -- "I believe that your breathing will continue to worsen, and we need to prepare for that."
An example of statements coded for length of life: "I expect that you will live for days to weeks, rather than months to years. About 30 percent of people live for a month or more."
An optimistic framing statement: "The good news is I expect you will live for a few more months. | I believe your chances of surviving up to six months are quite good."
An example of a statement coded for quality of life: "But you know you never know. Sometimes people perk up for awhile. And it may be with a little extra blood you'll perk up for awhile and we'll all enjoy it if you do."
Providing a palliative care consultat
|Contact: Leslie Orr|
University of Rochester Medical Center