Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice

Abstract

Background: There is growing recognition that a diverse range of healthcare professionals need competence in palliative approaches to care. Effective communication is a core component of such practice. This article informs evidence-based communication about illness progression and end of life through a rapid review of studies that directly observe how experienced clinicians manage such discussions.

Methods: The current rapid review updates findings of a 2014 systematic review, focussing more specifically on evidence related to illness progression and end-of-life conversations. Literature searches were conducted in nine bibliographic databases. Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about illness progression or end of life were eligible for inclusion in the review. An aggregative approach was used to synthesise the findings of included studies.

Results: Following screening, 26 sources were deemed to meet eligibility criteria. Synthesis of study findings identified the structure and functioning of ten communication practices used in discussions about illness progression and end-of-life.

Conclusion: The ten practices identified underpin five evidence-based recommendations for communicating with patients or family members about illness progression and end of life.

Keywords: Bad news; Communication; Conversation analysis; Difficult conversations; Discourse analysis; Palliative care; Rapid review; Serious news.

Fig. 1

Screening results