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Honest talk eases end-of-life choices

By Leslie Orr-Rochester
Futurity
June 1, 2012

To find out the best way to talk to someone about prognosis and quality of life when serious illness strikes, researchers at the University of Rochester Medical Center audio-recorded 71 palliative care discussions.

The study, published online in the Journal of Pain and Symptom Management, includes several key discoveries:

“Good communication might be the single most important element of palliative care,” says lead author Robert Gramling, associate professor of family medicine. “Through direct observation we have demonstrated how these talks occur and the important dimension they add at the end of life.”

The study took place at Strong Memorial Hospital at URMC, which has an in-patient hospice unit and provides more than 1,000 palliative care consultations annually. With prior consent from all study participants, researchers placed high-definition digital recorders in unobtrusive locations in hospital rooms before the prognosis discussions took place.

Afterward, researchers coded the conversations based on whom was speaking, the topic, and how the information was framed, and then analyzed the data. Some examples:

Providing a palliative care consultation has become much more complex in recent years. As the demand for these services has risen, so has the breadth of services.

Palliative care isn’t an either-or proposition—either relieving suffering or treating the illness medically, but has evolved into a combination of the two, along with opening communication with the patient and family so they know what to expect.

“When patients and families clearly understand the road ahead they can make the best decisions, based on their own values, desires, and goals,” Gramling adds. “Without correctly framing the facts, however, discussions can become unbalanced or lack the context to be helpful.”

Researchers from the University of Arizona and Duke University contributed to the study, which was funded by the National Palliative Care Research Center and the Greenwall Foundation.