Jun 25, 2020
This episode features Rebecca Anderson (Marie Curie
Palliative Care Research Department, Division of Psychiatry,
University College London, London, UK).
Honest prognostic communication with families of patients in the
final hours and days of life is important for enabling a good death
and for families’ preparedness for that death.
Prognostic uncertainty makes this communication challenging for
clinicians and families.
Clinicians provided what we term ‘absolute categorical time
estimates’ (suggesting a prognosis of ‘hours’ or ‘days’) and
explained how that prognosis was reached, allowing them to
reduce prognostic uncertainty without committing to an overly
specific timescale.
When requesting prognostic information, relatives helped to relieve
the burden of uncertainty for clinicians by alluding to their
awareness that prognostication is a subjective judgement.
Clinicians and relatives could be direct about prognosis without
explicitly referring to ‘death’ and ‘dying’, as references to time
were understood by both parties as referring to prognosis.
This paper identified key practices for communicating prognosis
with families of patients at the very end of life, such as
explicitly stating the uncertainty while invoking expertise,
and using absolute categorical time estimates when providing a
prognosis.
These practices could be taught as part of communication training
using clips of recordings from real-life interactions.
Full paper available from:
https://journals.sagepub.com/doi/full/10.1177/0269216320910934
If you would like to record a podcast about your published (or
accepted) Palliative Medicine paper, please contact
Dr Amara Nwosu:
a.nwosu@lancaster.ac.uk