How and when do patients request life-expectancy estimates? Evidence from hospice medical consultations and insights for practice
Funded by
3 April 2018
Published journal: ScienceDirect
AbstractÂ
Objective
To break new ground by directly examining how patients seek life-expectancy estimates, and how doctors support them in doing so.
Methods
Conversation analytic examination of 10 recorded UK hospice consultations involving 3 palliative specialists.
Results
Life expectancy estimate episodes frequently begin after a doctor has given a patient an opportunity to shape the consultation agenda. Rather than posing direct questions, patients cautiously display their interest in receiving an estimate using statements. These often contain preparatory information about: what they already know about their prognosis, their perspective on it, and readiness to hear more. When patients do not provide this information, doctors invite it before giving an estimate. Patients’ companions also contribute to this preparatory work.
Conclusion
Doctors, patients, and companions collaboratively work to prepare a conversational environment wherein emotional states and uncertainties have been addressed prior to delivery of the actual estimate. This helps manage both possible emotional distress, and prognostic uncertainty entailed in seeking and delivering estimates.
Practice implications
Clinicians should be mindful that rather than overtly requesting estimates, patients may seek them more cautiously. Before delivering estimates, doctors can support patients to articulate their existing understanding and perspective regarding prognosis, and their readiness to hear more.
Citation
Work with us
We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.
View current vacanciesThe Q community
Q is an initiative connecting people with improvement expertise across the UK.
Find out more