Dancing Around Death: Hospitalist-patient Communication About Serious Illness

Overview

Journal Qual Health Res

Publisher Sage Publications

Specialty Health Services

Date 2012 Oct 5

PMID 23034778

Citations 13

Authors

Wendy G Anderson

Susan Kools

Audrey Lyndon

Affiliations

Soon will be listed here.

Abstract

Hospital physicians care for most seriously ill patients in the United States. We employed dimensional analysis to describe communication about death and dying in audio-recorded admission encounters between seriously ill patients and hospitalists. Acknowledging or not acknowledging the possibility of dying emerged as a key process. Acknowledgment was rare, and depended on synergistic communication behaviors between patient and physician. Facilitators included patients cuing for information and disclosing emotional distress, and physicians exploring the patient's understanding of his or her illness and emotional distress. When hospitalists focused on acute issues, stated that they were awaiting test results, and deferred to other physicians, discussion moved away from acknowledgment. Meaningful discussion of end-of-life issues, including goals and values, fears about death and dying, prognosis, and options for palliative care followed open acknowledgment. This acknowledgment process can serve as a guide for providers to sensitively and honestly discuss essential end-of-life issues.

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References

Cohen J, Bilsen J, Addington-Hall J, Lofmark R, Miccinesi G, Kaasa S . Population-based study of dying in hospital in six European countries. Palliat Med. 2008; 22(6):702-10. DOI: 10.1177/0269216308092285. View

von Gunten C, Ferris F, Emanuel L . The patient-physician relationship. Ensuring competency in end-of-life care: communication and relational skills. JAMA. 2000; 284(23):3051-7. DOI: 10.1001/jama.284.23.3051. View

Dow L, Matsuyama R, Ramakrishnan V, Kuhn L, Lamont E, Lyckholm L . Paradoxes in advance care planning: the complex relationship of oncology patients, their physicians, and advance medical directives. J Clin Oncol. 2009; 28(2):299-304. PMC: 2815718. DOI: 10.1200/JCO.2009.24.6397. View

Anderson W, Chase R, Pantilat S, Tulsky J, Auerbach A . Code status discussions between attending hospitalist physicians and medical patients at hospital admission. J Gen Intern Med. 2010; 26(4):359-66. PMC: 3055965. DOI: 10.1007/s11606-010-1568-6. View

Temel J, Greer J, Muzikansky A, Gallagher E, Admane S, Jackson V . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733-42. DOI: 10.1056/NEJMoa1000678. View

Tattersall M, Gattellari M, Voigt K, Butow P . When the treatment goal is not cure: are patients informed adequately?. Support Care Cancer. 2002; 10(4):314-21. DOI: 10.1007/s005200100291. View

Fulton B, Drevs K, Ayala L, Malott Jr D . Patient satisfaction with hospitalists: facility-level analyses. Am J Med Qual. 2011; 26(2):95-102. DOI: 10.1177/1062860610381274. View

Pollak K, Arnold R, Jeffreys A, Alexander S, Olsen M, Abernethy A . Oncologist communication about emotion during visits with patients with advanced cancer. J Clin Oncol. 2007; 25(36):5748-52. DOI: 10.1200/JCO.2007.12.4180. View

Clayton J, Butow P, Arnold R, Tattersall M . Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer. 2005; 103(9):1965-75. DOI: 10.1002/cncr.21011. View

10.

Wachter R, Goldman L . The emerging role of "hospitalists" in the American health care system. N Engl J Med. 1996; 335(7):514-7. DOI: 10.1056/NEJM199608153350713. View

11.

Pardon K, Deschepper R, Vander Stichele R, Bernheim J, Mortier F, Bossuyt N . Changing preferences for information and participation in the last phase of life: a longitudinal study among newly diagnosed advanced lung cancer patients. Support Care Cancer. 2012; 20(10):2473-82. DOI: 10.1007/s00520-011-1369-4. View

12.

Prigerson H . Socialization to dying: social determinants of death acknowledgement and treatment among terminally ill geriatric patients. J Health Soc Behav. 1992; 33(4):378-95. View

13.

Lee K, Yang Y, Yang K, Ong B, Ng H . Bringing generalists into the hospital: outcomes of a family medicine hospitalist model in Singapore. J Hosp Med. 2011; 6(3):115-21. DOI: 10.1002/jhm.821. View

14.

Kaldjian L, Erekson Z, Haberle T, Curtis A, Shinkunas L, Cannon K . Code status discussions and goals of care among hospitalised adults. J Med Ethics. 2009; 35(6):338-42. DOI: 10.1136/jme.2008.027854. View

15.

Plauth 3rd W, Pantilat S, Wachter R, Fenton C . Hospitalists' perceptions of their residency training needs: results of a national survey. Am J Med. 2001; 111(3):247-54. DOI: 10.1016/s0002-9343(01)00837-3. View

16.

Kuo Y, Sharma G, Freeman J, Goodwin J . Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009; 360(11):1102-12. PMC: 2977939. DOI: 10.1056/NEJMsa0802381. View

17.

Broom A, Adams J . The reconfiguration of expertise in oncology: the practice of prediction and articulation of indeterminacy in medical consultations. Qual Health Res. 2010; 20(10):1433-45. DOI: 10.1177/1049732310373042. View

18.

Weeks J, Cook E, ODay S, Peterson L, Wenger N, Reding D . Relationship between cancer patients' predictions of prognosis and their treatment preferences. JAMA. 1998; 279(21):1709-14. DOI: 10.1001/jama.279.21.1709. View

19.

Maa J, Carter J, Gosnell J, Wachter R, Harris H . The surgical hospitalist: a new model for emergency surgical care. J Am Coll Surg. 2007; 205(5):704-11. DOI: 10.1016/j.jamcollsurg.2007.05.008. View

20.

Mussman G, Conway P . Pediatric hospitalist systems versus traditional models of care: effect on quality and cost outcomes. J Hosp Med. 2011; 7(4):350-7. DOI: 10.1002/jhm.951. View