Directly Observed Patient–Physician Discussions in Palliative and End-of-Life Care: A Systematic Review of the Literature

Abstract

Objectives: To review studies that used direct observation (i.e., videotaping or audiotaping) methods in palliative/end-of-life care communication research. Design: Descriptive thematic analysis. Setting: Multinational studies were conducted in both the outpatient and inpatient setting. Measurements: Extensive bibliographic searches (January 1, 1998 to July 31, 2009) of English-language literature involving physician-patient (or physician-family) interactions were conducted and augmented by reviews of reference listings. Three investigators independently abstracted key information from each article. Results: Of the 20 retained articles, most enrolled young-old participants (mean age, 60 years) who were white and had a cancer diagnosis. Patient/family participation rates ranged from 68% to 89% demonstrating feasibility of this approach when studying palliative/end-of-life care communication issues. Four common themes were identified: (1) physicians focus on medical/technical and avoid emotional/quality of life issues; (2) sensitive topics are perceived by physicians to take longer to discuss and often do take longer to discuss; (3) physicians dominate discussions; and (4) patient/family satisfaction is associated with supportive physician behaviors. Conclusions: This study demonstrates that direct observation methods can be feasibly used when studying physician-patient/physician-family communication in palliative/end-of-life care, but few investigations have utilized this approach. This article highlights areas that need improvement, including physicians' ability to address patient/family emotional issues and provide what patients and families find most satisfying (participation and support). A particular focus on older patients and patients with end-stage or late-stage chronic (noncancer) illness, the adaptation/application of existing communication measurement tools to capture palliative care communication issues, and development of corresponding outcome measures to assess impact is now needed.

Talking With Parents About End-of-Life Decisions for Their Children

“…[39][40][41][42][43][44] What our study adds is the insight that parents appreciated receiving this detailed information, as evidenced by their reactions and their questions in return. It may be postulated that the provision of relevant information helps parents to grasp what is happening to their child and regain some feeling of control.…”

Information Provision and Patient Reported Outcomes in Patients with Metastasized Colorectal Cancer: Results from the PROFILES Registry

“…A possible explanation for the absence of this association is that next to the amount of information, the content of information and the way the information is provided are at least equally important for the satisfaction levels of patients with mCRC. 38 Furthermore, patient satisfaction is associated with supportive HCP behaviors 33 ; the way information is provided (although not assessed in this study) could influence the way information will be perceived. 16 Patients with advanced cancer want the HCP to be honest, to convey hope, to speak plain language instead of difficult medical terminology, to be empathic, to give enough time during discussion, and to pace the amount of information to what they can assimilate.…”

“…32 HCPs are inclined to give routine medical/technical information (diagnosis, type of treatment) and avoid emotional and quality-of-life issues. 33 Furthermore, patients with mCRC possibly want (and expect) more direct emotional support from their HCP instead of only a referral to more formal organized support. 32 Our results do not show differences in the perceived level of received information between patients with or without mCRC.…”

Advanced Care Directives: Overcoming the Obstacles

“…6 In the intensive care unit setting, a structured case-based curriculum did improve confidence in discussing acute end-of-life issues. 7 Research found that a simple 1-hour education session for ambulatory care improves completion of ACD paperwork, but data are lacking regarding educational interventions for ambulatory residency training.…”