'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication

BMJ Open. 2014 Oct 8;4(10):e005653. doi: 10.1136/bmjopen-2014-005653.

Abstract

Objective: To understand patients' preferences for physician behaviours during end-of-life communication.

Methods: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer).

Results: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information.

Conclusions: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.

Keywords: advance care planning; critical illness; end-of-life communication; patient preference; physician-patient relations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Advance Care Planning
  • Advance Directives
  • Aged
  • Canada
  • Communication*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Preference*
  • Physician-Patient Relations*
  • Qualitative Research
  • Terminal Care*
  • Truth Disclosure*