Issues in prognostication for hospital specialist palliative care doctors and nurses: A qualitative inquiry

Pontin, David; Jordan, Nicola

doi:10.1177/0269216311432898

Cited by 25 publications

(30 citation statements)

References 31 publications

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“…However, an accurate prognostication of survival in those with nonmalignant diseases seems to be difficult and may lead to postponement of medical decisions. 26 This prognostic paralysis can be overcome to some extent by the early instigation of discussion of the patient's preferences and wishes about their end of life (advance care planning). This approach may enhance trust between the physician and the patient leading to acceptance of the withdrawal of lifelong medication.…”

Section: Discussionmentioning

confidence: 99%

Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

Noortgate

Verhofstede

Cohen

et al. 2016

Journal of Pain and Symptom Management

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Section: Discussionmentioning

confidence: 99%

Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

Noortgate

Verhofstede

Cohen

et al. 2016

Journal of Pain and Symptom Management

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“…In the first method, CES, has been summarised as a ‘personal clinical judgement’ that is subjective in nature with complex and poorly defined variables 1. Pontin and Jordan recently reported the findings of their study addressing views on the overall prognostication experience among a cohort of palliative care clinicians 9. The study provides an important overview of the clinicians’ experience and particularly underscores the potential impact of CES inaccuracy on clinicians themselves and the fear and uncertainty often experienced.…”

Section: Discussionmentioning

confidence: 99%

A qualitative analysis of the elements used by palliative care clinicians when formulating a survival estimate

Clarkson

Selby

Myers

2012

BMJ Support Palliat Care

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ObjectiveFor patients with advanced and/or incurable disease, clinicians are often called upon to formulate and communicate an estimate of likely survival duration. The objective of this study was to gain a deeper appreciation of this process by identifying and exploring the specific elements that may inform and/or impact a clinician's estimate of survival (CES).MethodsSemistructured interviews were conducted among a group of palliative care clinicians in the setting of a tertiary academic health sciences centre. Qualitative data were subsequently analysed using a grounded theory approach.ResultsFive major themes were identified as being central to the process of CES formulation: use of objective patient-specific elements, strength of the patient-clinician relationship, purpose and context of an individual CES, perceived role of hope and the overall likelihood of CES inaccuracy.ConclusionsFor any given patient, several elements have the potential to inform and/or impact the process of CES formulation. Study participants were aware of objective clinical factors known to correlate with actual survival duration and likely integrate this information when formulating a CES. Formulation occurs within a larger context comprised of a number of elements that may influence individual estimates. These elements exist against a background of awareness of the overall likelihood of CES inaccuracy. Clinicians are encouraged to develop a personalised and standardised approach to CES formulation whereby an awareness of the menu of potentially impacting elements is consciously integrated into an individual process.

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“… 5 6 Surveys of clinicians have found that they report lack of confidence, skills and knowledge about how to initiate such discussions, making them reticent to do so. 7 Clinicians also report that these conversations can be uncomfortable and challenging, 8 with difficulties including ascertaining patients’ preferences, and deciding on the ‘right time’ to raise such matters. 7 These challenges are exacerbated by patients’ and their companions’ own reticence and ambivalence with regard to initiating these conversations.…”

Section: Introductionmentioning

confidence: 99%

How to communicate with patients about future illness progression and end of life: a systematic review

Parry

Land

Seymour

2014

BMJ Support Palliat Care

104

111

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BackgroundConversation and discourse analytic research has yielded important evidence about skills needed for effective, sensitive communication with patients about illness progression and end of life.ObjectivesTo: ▸ Locate and synthesise observational evidence about how people communicate about sensitive future matters;▸ Inform practice and policy on how to provide opportunities for talk about these matters;▸ Identify evidence gaps.DesignSystematic review of conversation/discourse analytic studies of recorded interactions in English, using a bespoke appraisal approach and aggregative synthesis.Results19 publications met the inclusion criteria. We summarised findings in terms of eight practices: ‘fishing questions’—open questions seeking patients’ perspectives (5/19); indirect references to difficult topics (6/19); linking to what a patient has already said—or noticeably not said (7/19); hypothetical questions (12/19); framing difficult matters as universal or general (4/19); conveying sensitivity via means other than words, for example, hesitancy, touch (4/19); encouraging further talk using means other than words, for example, long silences (2/19); and steering talk from difficult/negative to more optimistic aspects (3/19).ConclusionsPractices vary in how strongly they encourage patients to engage in talk about matters such as illness progression and dying. Fishing questions and indirect talk make it particularly easy to avoid engaging—this may be appropriate in some circumstances. Hypothetical questions are more effective in encouraging on-topic talk, as is linking questions to patients’ cues. Shifting towards more ‘optimistic’ aspects helps maintain hope but closes off further talk about difficulties: practitioners may want to delay doing so. There are substantial gaps in evidence.

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Issues in prognostication for hospital specialist palliative care doctors and nurses: A qualitative inquiry

Abstract: Findings highlight lack of evidence to support practice, and identify the complexity and emotional labour involved in prognostication by hospital specialist palliative care team members, and are used to discuss recommendations for further research and practice.

Cited by 25 publications

References 31 publications

Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

Prescription and Deprescription of Medication During the Last 48 Hours of Life: Multicenter Study in 23 Acute Geriatric Wards in Flanders, Belgium

A qualitative analysis of the elements used by palliative care clinicians when formulating a survival estimate

How to communicate with patients about future illness progression and end of life: a systematic review

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