Addressing possible problems with patients’ expectations, plans and decisions for the future One strategy used by experienced clinicians in advance care planning conversations

Funded by

The Health Foundation Logo

1 April 2019

Published journal: Science Direct

Abstract

Objective

Giving terminally ill people opportunities to participate in advance care planning involves tensions between: endorsing and supporting patients’ expectations, plans and decisions, and addressing how realistic these are. The latter risks exerting undue pressure to change plans; undermining autonomy; jeopardising therapeutic relationships. Our objective is to describe how experienced hospice doctors raise potential/actual problems with patients’ expectations, plans or decisions.

Methods

Conversation analysis of video-recorded consultations between five UK hospice consultants, 37 patients and their companions.

Results

Eleven episodes involving five doctors were found. In all of these we identified a ‘Hypothetical Scenario Sequence’ where doctors raise a hypothetical future scenario wherein current plans/expectations turn out to be problematic, then engage patients in discussing what could be done about this. We describe features of this sequence and how it can circumvent the risks of addressing problems with patients’ expectations and plans.

Conclusion

Our research breaks new ground, showing that by treating expectations, plans and decisions as potentially not actually problematic, practitioners can recognise and support patients’ preferences whilst preparing them for possible difficulties and inevitable uncertainties.

Practice Implications

Where professionals judge it appropriate to raise problems about patients’ preferences, plans and decisions, this sequence can manage the associated risks.

Citation

 Ford, J., Hepburn, A., & Parry, R. (2019). What do displays of empathy do in palliative care consultations? Discourse Studies, 21(1), 22–37. https://doi.org/10.1177/1461445618814030
 

You might also like...

Blog

Three key quality considerations for remote consultations

COVID-19 has led to the rapid roll-out of remote consultations in order to meet social distancing...

Press release

Worst January for people waiting longer than four hours in A&E

Health Foundation response to January 2020 NHS England performance statistics

Blog

How can unnecessary outpatient appointments be reduced?

Outpatient hospital appointments have nearly doubled since 2007/08 to 120 million a year, with the...

Kjell-bubble-diagramArtboard 101 copy

Get social

Over 700,000 patients served by GPs at high risk of COVID-19 could be left without access to face to face GP appoin… https://t.co/wZJJPCuRCn

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more