General practitioners' strategies and tactics of communication with the terminally ill

Abstract

Interviews with 22 randomly selected general practitioners (GPs) investigated their communication with terminally ill patients. In interview analysis a conceptual distinction was drawn between objectives, strategies and tactics. When treating terminal patients, GPs expressed the objectives of keeping the patient comfortable, painfree, happy and maintaining dignity. A strategy is a plan and mode of approaching patients existing over an extended time period. Three strategies were described by GPs for use when interacting with terminally ill patients. These are characterized as 'try to disclose', 'let the patient decide' and 'avoid disclosing'. Tactics refer to behaviours used within a single consultation, as part of a strategy. Six tactics are described: evasion, denial, uncertainty, hints and prompts, euphemism and reassurance. Different strategies imply quite different forms of consultation. Thus to understand a consultation we must place it into the context of the series.