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

Anderson, R; Stone, P; Low, J; Bloch, S; (2021) Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study. Patient Education and Counseling 10.1016/j.pec.2020.10.009. (In press). Green open access

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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.

Type: Article
Title: Transitioning out of prognostic talk in discussions with families of hospice patients at the end of life: A conversation analytic study
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.pec.2020.10.009
Publisher version: https://doi.org/10.1016/j.pec.2020.10.009
Language: English
Additional information: This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Communication, Conversation analysis, End of life, Palliative care, Hospice, Uncertainty, Prognosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Language and Cognition
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10111662
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