A Longitudinal Examination of Enacted Goal Attention in End-of-Life Communication in Families

Abstract

Drawing on theoretical principles related to goal pursuit and inference, the present study investigated the extent to which specific message features led to better or worse conversational outcomes of end-of-life discussions between older adults and their adult children. Actor-partner interdependence modeling analysis of longitudinal reports from 66 parent/child dyads revealed that tactical attention to identity, relational, and task goals in conversation predicted change over a 1-year period in advance directive completion, concordance accuracy, and relationship satisfaction and closeness. Quantity features of communication (i.e., number of conversations, number of topics discussed) were not related to the measured outcomes. Routine relationship maintenance and explicit decision making had a positive impact on the outcomes, and underaccommodation, strategic relationship maintenance, avoidance, elaboration, and implicit decision making had a negative impact on the outcomes of end-of-life family talk. The findings provide insight on how to practically improve the quality of end-of-life conversations in families.

A mixed methods study exploring requests for unproven COVID therapies such as ivermectin and healthcare distrust in the rural South

“…Problems with healthcare trust and high-quality communication between clinicians and patients are by no means a problem exclusive to the COVID-19 pandemic or UCTs. Extensive literature on clinician-patient communication points to various strategies that may help clinicians improve their ability to communicate effectively with patients, including attending to relational and identity goals in addition to their task goal within the conversation ( Scott and Van Scoy, 2020 , Scott, 2022 ). Doing so can be done by demonstrating empathy, acknowledging different perspectives and identities, building relational rapport over time, and demonstrating genuine interest in patients’ lives and concerns ( Scott and Van Scoy, 2020 ).…”

What does the doctor plan to say? Physician-generated plans for advance care planning conversations

“…Caughlin, 2010). If a speaker fails to pursue situationally relevant goals in a conversation, their communication is evaluated negatively by others and can potentially influence emotional and relational outcomes (Caughlin, 2010;Scott, 2022). For instance, Scott and Caughlin (2014) found that in family EOL conversations, messages involving relational-oriented goals were associated with higher levels of conversational satisfaction and hopefulness.…”

“…Theoretical underpinnings of planning theory and multiple goals allow cross-study comparisons to be formulated. While topic categories were identified for the purposes of the existing study, considering those topics in a broader categorization of salient goal orientations as outlined by multiple goal theorists help contribute to a systematic build of this research trajectory in the context of EOL care (Scott, 2022). Findings also gave credence to the utility of planning theory in affording insight to conversational orientation.…”

“…One challenge in investigating ACP conversations is the numerous existent patient and contextual variations that exist (e.g., Considine & Miller, 2010;Scott, 2022). A means to glean insight regarding physician approaches is the use of planning theory (Berger, 1988;1997) and conversational plans in lieu of actual conversations.…”

Comparing two advance care planning conversation activities to motivate advance directive completion in underserved communities across the USA: The Project Talk Trial study protocol for a cluster, randomized controlled trial

“…Audio recordings are transcribed verbatim for Communication Quality Analysis (CQA). CQA is a rigorous coding method for assessing clinical communication quality and is grounded in the Multiple Goals Theory of Communication [81][82][83][84][85]. Briefly, Multiple Goals Theory is a framework that defines high-quality communication as the extent to which three broad communication goals are achieved: (1) task goals (completing a task), (2) relational goals (maintaining healthy relationships with others), and (3) identity goals (managing Two surveys were removed from protocol after three events due to survey burdens on participants (social support questionnaire and ACP values and beliefs) a Includes race, ethnicity, gender, age, education, income, SES, religiosity, health status, marital status, experience with health decisions, medical decision maker presence at event, etc.…”