Hostname: page-component-84b7d79bbc-5lx2p Total loading time: 0 Render date: 2024-07-29T05:06:56.756Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Ahluwalia, S.C., Levin, J.R., Lorenz, K.A., et al. (2012). Missed opportunities for advance care planning communication during outpatient clinic visits. Journal of General Internal Medicine, 27(4), 445. doi: 10.1007/s11606-011-1917-0.CrossRefGoogle ScholarPubMed
Ahluwalia, S.C., Levin, J.R., Lorenz, K.A., et al. (2013). “There's no cure for this condition”: How physicians discuss advance care planning in heart failure. Patient Education and Counseling, 91(2), 200. doi: 10.1016/j.pec.2012.12.016.CrossRefGoogle ScholarPubMed
Ainsworth-Vaughn, N. (1998). Claiming power in doctor–patient talk. New York: Oxford University Press.CrossRefGoogle Scholar
Barnes, K.A., Barlow, C.A., Harrington, J., et al. (2011). Advance care planning discussions in advanced cancer: Analysis of dialogues between patients and care planning mediators. Palliative & Supportive Care, 9(1), 73. doi: 10.1017/S1478951510000568.CrossRefGoogle ScholarPubMed
Bradley, E.H., Hallemeier, A.G., Fried, T.R., et al. (2001). Documentation of discussions about prognosis with terminally ill patients. The American Journal of Medicine, 111(3), 218. doi: 10.1016/S0002-9343(01)00798-7.CrossRefGoogle ScholarPubMed
Burchardi, N., Rauprich, O., Hecht, M., et al. (2005). Discussing living wills: A qualitative study of a German sample of neurologists and ALS patients. Journal of the Neurological Sciences, 237(1–2), 67. doi: 10.1016/j.jns.2005.05.013.CrossRefGoogle Scholar
Cherlin, E., Fried, T., Prigerson, H.G., et al. (2005). Communication between physicians and family caregivers about care at the end of life: When do discussions occur and what is said? Journal of Palliative Medicine, 8(6), 1176. doi: 10.1089/jpm.2005.8.1176.CrossRefGoogle ScholarPubMed
Clarke, A. & Seymour, J. (2010). “At the foot of a very long ladder”: Discussing the end of life with older people and informal caregivers. Journal of Pain and Symptom Management, 40(6), 857. doi: 10.1016/j.jpainsymman.2010.02.027.CrossRefGoogle ScholarPubMed
Cordella, M. (2004). The dynamic consultation: A discourse analytical study of doctor–patient communication. Amsterdam: John Benjamins.CrossRefGoogle Scholar
Detering, K.M., Hancock, A.D., Reade, M.C., et al. (2010). The impact of advance care planning on end-of-life care in elderly patients: Randomised controlled trial. BMJ (Clinical Research ed.), 340(1), c1345. doi: 10.1136/bmj.c1345.CrossRefGoogle ScholarPubMed
Emerson, R.M., Fretz, R.I. & Shaw, L.L. (2011). Writing ethnographic fieldnotes, 2nd ed. Chicago: The University of Chicago Press.CrossRefGoogle Scholar
Heritage, J. & Maynard, D.W. (2006). Communication in medical care: Interaction between primary care physicians and patients, 1st ed. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Meeuwesen, L., Schaap, C. & van der Staak, C. (1991). Verbal analysis of doctor–patient communication. Social Science & Medicine, 32(10), 1143. doi: 10.1016/0277-9536(91)90091-P.CrossRefGoogle ScholarPubMed
Mullick, A., Martin, J. & Sallnow, L. (2013). An introduction to advance care planning in practice. BMJ (Clinical Research ed.), 347, f6064.Google ScholarPubMed
Neergaard, M.A., Jensen, A.B., Sondergaard, J., et al. (2011). Preference for place-of-death among terminally ill cancer patients in Denmark. Scandinavian Journal of Caring Sciences, 25(4), 627–636.CrossRefGoogle ScholarPubMed
Ong, L.M.L., de Haes, J.C.J.M., Hoos, A.M., et al. (1995). Doctor–patient communication: A review of the literature. Social Science & Medicine, 40(7), 903. doi: 10.1016/0277-9536(94)00155-M.CrossRefGoogle ScholarPubMed
Pilnick, A. & Dingwall, R. (2011). On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science & Medicine, 72(8), 1374. doi: 10.1016/j.socscimed.2011.02.033.CrossRefGoogle ScholarPubMed
Romer, A.L. & Hammes, B.J. (2004). Communication, trust, and making choices: Advance care planning four years on. Journal of Palliative Medicine, 7(2), 335. doi: 10.1089/109662104773709495.CrossRefGoogle Scholar
Roter, D.L., Larson, S., Fischer, G.S., et al. (2000). Experts practice what they preach: A descriptive study of best and normative practices in end-of-life discussions. Archives of Internal Medicine, 160(22), 3477. doi: 10.1001/archinte.160.22.3477.CrossRefGoogle ScholarPubMed
Siegler, E.L. & Levin, B.W. (2000). Physician–older patient communication at the end of life. Clinics in Geriatric Medicine, 16(1), 175. doi: 10.1016/S0749-0690(05)70016-1.CrossRefGoogle ScholarPubMed
Sorensen, R. & Iedema, R. (2009). Emotional labour: Clinicians' attitudes to death and dying. Journal of Health Organization and Management, 23(1), 5. doi: 10.1108/14777260910942524.CrossRefGoogle ScholarPubMed
Tulsky, J.A., Fischer, G.S., Rose, M.R., et al. (1998). Opening the black box: How do physicians communicate about advance directives? Annals of Internal Medicine, 129(6), 441. doi: 10.1059/0003-4819-129-6-199809150-00003.CrossRefGoogle ScholarPubMed
Waldrop, D.P. & Meeker, M.A. (2012). Communication and advanced care planning in palliative and end-of-life care. Nursing Outlook, 60(6), 365. doi: 10.1016/j.outlook.2012.08.012.CrossRefGoogle ScholarPubMed
Wright, A.A., Zhang, B., Ray, A., et al. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. The Journal of the American Medical Association, 300(14), 1665. doi: 10.1001/jama.300.14.1665.CrossRefGoogle ScholarPubMed