Encouraging and discouraging talk about illness progression, dying and death: a systematic review of communication research

Encouraging and discouraging talk about illness progression, dying and death: a systematic review of communication research

Parry RH; Land V; Seymour J

Bmj Supportive & Palliative Care

2013

ICU Decision Making; Best Practices (Davies)

Introduction Communicating with patients about their feelings and preferences for the future is a challenging element of palliative care. Useful evidence exists, but most is embedded in social-scientific rather than clinical research.Aims and Methods To collate evidence about communication practices used in addressing sensitive future issues, from studies where patient/professional conversations have been recorded and analysed. To inform communication policy, practice and training. This innovative systematic review spanned social science, clinical and linguistics research. Using explicit criteria, we searched electronic databases and specialist sources. We used review and synthesis techniques appropriate for social-science research.Results 2203 publications were initially identified. Of the 18 meeting the inclusion criteria, 5 were social science, five clinical and eight linguistics publications. Strong evidence (11/18) indicates hypothetical questions are effective in encouraging people to address feelings and plans for uncertain and difficult futures. Moderate evidence (5/18) indicates that another way to create such opportunities entails using cautious, euphemistic language; and that this provides distinctive opportunities for people to deflect or avoid the topic. Moderate evidence (3/21) indicates that people often steer such conversations towards more optimistic statements, which tends to stop further talk about difficult events.Conclusions Social-science, linguistic and clinical evidence is available to inform this skilled, often problematic element of care. There are different ways to provide opportunities to discuss feelings and plans in relation to end of life. Different ways have different results: better understandings of these will facilitate evidence-based communication. To fill gaps in knowledge, further research using recordings of authentic palliative care consultations is needed.

2013

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