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Talking about sensitive topics during the advance care planning discussion: A peek into the black box

Published online by Cambridge University Press:  02 June 2015

Pernille Andreassen ,
Mette Asbjørn Neergaard ,
Trine Brogaard ,
Marianne Hjorth Skorstengaard  and
Anders Bonde Jensen
Pernille Andreassen*
Affiliation:
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Mette Asbjørn Neergaard
Affiliation:
The Palliative Team, Aarhus University Hospital, Aarhus, Denmark
Trine Brogaard
Affiliation:
Department of Public Health, Aarhus University Hospital, AarhusDenmark
Marianne Hjorth Skorstengaard
Affiliation:
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Anders Bonde Jensen
Affiliation:
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
*
Address correspondence and reprint requests to: Pernille Andreassen, Onkologisk Afdeling, Nørrebrogade 44, Building 5, 2., 8000 Århus C., Denmark. E-mail: pernandr@rm.dk or andreassenpernille@hotmail.com
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Abstract

Objective:

Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor–patient interactions.

Method:

Following a discourse-analysis approach, the study uses the concept of doctor and patient “voices” to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark.

Results:

Previous studies of directly observed patient–physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance.

Significance of Results:

Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.

Keywords

Advance care planning (ACP)CommunicationDiscourse analysisFuture carePalliative care
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1669 - 1676
Copyright
Copyright © Cambridge University Press 2015 

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