Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Aug 4;3(1):116-122.
doi: 10.1089/pmr.2022.0024. eCollection 2022.

Patterns of Communication About Serious Illness in the Years, Months, and Days before Death

Mattias Tranberg  1   2 , Juliet Jacobsen  2   3   4 , Carl Johan Fürst  1   2 , Jacob Engellau  5 , Maria E C Schelin  1   2
Affiliations

Patterns of Communication About Serious Illness in the Years, Months, and Days before Death

Mattias Tranberg et al. Palliat Med Rep. .

Abstract

Background: Communication with patients and families about serious illness impacts quality of life and helps facilitate decision-making.

Objective: To elucidate the pattern of communication about serious illness for patients who have died in an inpatient setting.

Design: Three hundred patients from the Swedish Registry of Palliative Care 2015-2017 were randomly selected for manual chart review.

Setting: Patients who died in a palliative care, oncology, or internal medicine unit in Sweden were selected.

Measurements: We report on the frequency of conversations at three time points, 6 months or longer before death ("Years"), 15 days-6 months before death ("Months"), and 0-14 days before death ("Days"). We also report the timing of the conversation about dying.

Results: A total of 249 patients were included after exclusions; they had an average of 2.1 conversations (range 1-6). The first conversation took place a median of 53 days before death and the last conversation took place a median of 9 days before death. Separate conversations with the next of kin took place a median of two days before death. We could verify a conversation about dying in only 156/249 (63%) medical records.

Conclusions: Communication about serious illness between clinicians, patients, and families occurs iteratively over a period before death. Measuring the quality of communication about serious illness using a years, months, and days framework may help ensure that patients and families have sufficient information for medical and personal decision making.

Keywords: communication; end of life; patients; physicians; serious illness; transition.

PubMed Disclaimer

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
A time-related framework to help identify transitions and conversations in a palliative care and disease trajectory.
FIG. 2.
FIG. 2.
A view of all documented conversations in the medical records, over years, months, and days before death. On top, there is a frequency graph of the timing of conversations.
See this image and copyright information in PMC

References

    1. Bernacki R, Paladino J, Neville BA, et al. : Effect of the serious illness care program in outpatient oncology: A cluster randomized clinical trial. JAMA Intern Med 2019;179:751–759. - PMC - PubMed
    1. Haun MW, Estel S, Rucker G, et al. : Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017;6:CD011129. - PMC - PubMed
    1. Curtis JR, Engelberg R, Young JP, et al. : An approach to understanding the interaction of hope and desire for explicit prognostic information among individuals with severe chronic obstructive pulmonary disease or advanced cancer. J Palliat Med 2008;11:610–620. - PubMed
    1. Pino M and Parry R: Talking about death and dying: Findings and insights from five conversation analytic studies. Patient Educ Couns 2019;102(2):185–187. - PubMed
    1. Palliativ vård – förtydligande och konkretisering av begrepp (Palliative care - clarification and concretization of concepts.) Socialstyrelsen 2018. https://www.socialstyrelsen.se/Lists/Artikelkatalog/Attachments/21059/20...

LinkOut - more resources