Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study

Abstract

Objective: To examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients.

Methods: Conversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice.

Results: Following the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort.

Conclusion: In conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care.

Practice implications: In a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.

Keywords: Communication; Conversation analysis; End of life; Hospice; Palliative care; Prognosis; Uncertainty.