Epidemiology of Connectional Silence in specialist serious illness conversations

Cailin J Gramling; Brigitte N Durieux; Laurence A Clarfeld; Ali Javed; Jeremy E Matt; Viktoria Manukyan; Tess Braddish; Ann Wong; Joseph Wills; Laura Hirsch; Jack Straton; Nicholas Cheney; Margaret J Eppstein; Donna M Rizzo; Robert Gramling

doi:10.1016/j.pec.2021.10.032

Epidemiology of Connectional Silence in specialist serious illness conversations

Patient Educ Couns. 2022 Jul;105(7):2005-2011. doi: 10.1016/j.pec.2021.10.032. Epub 2021 Nov 6.

Authors

Affiliations

¹ University of Vermont, Burlington, VT, USA.
² Department of Computer Science, University of Vermont, Burlington, VT, USA.
³ Complex Systems & Data Science, University of Vermont, Burlington, VT, USA.
⁴ InSpace Proximity, Burlington, VT, USA.
⁵ Department of Family Medicine, University of Vermont, Burlington, VT, USA.
⁶ Department of Civil Engineering, University of Vermont, Burlington, VT, USA.
⁷ Department of Family Medicine, University of Vermont, Burlington, VT, USA. Electronic address: robert.gramling@med.uvm.edu.

PMID: 34799186
DOI: 10.1016/j.pec.2021.10.032

Abstract

Context: Human connection can reduce suffering and facilitate meaningful decision-making amid the often terrifying experience of hospitalization for advanced cancer. Some conversational pauses indicate human connection, but we know little about their prevalence, distribution or association with outcomes.

Purpose: To describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.

Methods: We audio-recorded 226 inpatient palliative care consultations at two academic centers. We identified pauses lasting 2+ seconds and distinguished Connectional Silences from other pauses, sub-categorized as either Invitational (ICS) or Emotional (ECS). We identified treatment decisional status pre-consultation from medical records and post-consultation via clinicians. Patients self-reported quality-of-life before and one day after consultation.

Results: Among all 6769 two-second silences, we observed 328 (4.8%) ECS and 240 (3.5%) ICS. ECS prevalence was associated with decisions favoring fewer disease-focused treatments (OR_adj: 2.12; 95% CI: 1.12, 4.06). Earlier conversational ECS was associated with improved quality-of-life (p = 0.01). ICS prevalence was associated with clinicians' prognosis expectations.

Conclusions: Connectional Silences during specialist serious illness conversations are associated with decision-making and improved patient quality-of-life. Further work is necessary to evaluate potential causal relationships.

Practice implications: Pauses offer important opportunities to advance the science of human connection in serious illness decision-making.

Keywords: Cancer; Communication; Conversation; Palliative care; Pause; Silence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Communication
Critical Illness / epidemiology
Critical Illness / therapy
Humans
Neoplasms* / epidemiology
Neoplasms* / therapy
Palliative Care
Physician-Patient Relations*
Referral and Consultation