Supportive Care in Cancer

, Volume 18, Issue 4, pp 399–408

Ways of talking about illness and prognosis in palliative cancer care consultations—two interactional frames

  • Eva Lidén
  • Joakim Öhlén
  • Lars-Christer Hydén
  • Febe Friberg
Original Article

Abstract

Goals of work

The purpose of the study was to describe how interaction about changes in illness and prognosis was shaped by participants in outpatient palliative cancer care consultations.

Patients and methods

The data collection involved six video-recorded consultations at an outpatient oncology unit at a university hospital in Sweden. The interactions were studied by means of discourse analysis. Inclusion criteria for the patients were gastro-intestinal cancer and receiving palliative care. The sample included three men and three women, aged 54–70, with various metastasised gastro-intestinal tumours. Significant others (SOs) were included where patients brought one to the consultation. Three male consultants aged 55–59 participated.

Main results

In palliative care consultations, the person-to-person and the patient–professional conversation frames were found to be in use as patients, SOs and physicians talked about the patients’ illness and prognosis. Within the patient–professional frame, three interactional patterns were found: the patient emphasising emotional experiences of illness or well-being and the physicians responding by toning down strategies, patients asking direct questions and getting straight answers and finally interaction marked by cautiousness and avoidances. Within the person–person frame, the interactions were described as: playful talk, collegial talk and existential talk.

Conclusions

When patients shared their personal interpretations of illness and prognosis, their narrative was more enhanced by the person-to-person frame than the patient–professional frame. Finding out if and how patients and SOs want to express their worries and finding a balance between the interactional patterns that occur are ethical challenges which health professionals must face. Since patients and SOs may restrain their emotional experiences, investigating grounded ways of overcoming these difficulties is imperative.

Keywords

Communication Palliative cancer care Outpatient consultations Interaction 

References

  1. 1.
    Anderson WG et al (2008) “What concerns me is...” Expression of emotion by advanced cancer patients during outpatient visits. Support Care Cancer 16:803–811. doi:10.1007/s00520-007-0350-8 CrossRefPubMedGoogle Scholar
  2. 2.
    Baider L (2008) Communicating about illness: a family narrative. Support Care Cancer 16:607–611. doi:10.1007/s00520-007-0370-4 CrossRefPubMedGoogle Scholar
  3. 3.
    Beach WA et al (2005) Disclosing and responding to cancer “fears” during oncology interviews. Soc Sci Med 60:893–910. doi:10.1016/j.socscimed.2004.06.031 CrossRefPubMedGoogle Scholar
  4. 4.
    Burns C et al (2007) Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process. Support Care Cancer 15(2):187–196. doi:10.1007/s00520-006-0116-8 CrossRefPubMedGoogle Scholar
  5. 5.
    Butow P et al (2004) Cancer consultation preparation package: changing patients but not physicians is not enough. J Clin Oncol 22(21):4401–4409. doi:10.1200/JCO.2004.66.155 CrossRefPubMedGoogle Scholar
  6. 6.
    Butow PN et al (2002) Oncologists’ reactions to cancer patients’ verbal cues. Psychooncology 11(1):47–58. doi:10.1002/pon.556 CrossRefPubMedGoogle Scholar
  7. 7.
    Bülow PH (2004) Sharing experiences of contested illness by storytelling. Discourse Soc 15(1):33–53. doi:10.1177/0957926504038943 CrossRefGoogle Scholar
  8. 8.
    Clayton JM et al (2005) Discussing end-of-life issues with terminally ill cancer patients and their carers: a qualitative study. Support Care Cancer 13(8):589–599. doi:10.1007/s00520-004-0759-2 CrossRefPubMedGoogle Scholar
  9. 9.
    Coleman T (2000) Using video-recorded consultations for research in primary care: advantages and limitations. Fam Pract 17(5):422–427. doi:10.1093/fampra/17.5.422 CrossRefPubMedGoogle Scholar
  10. 10.
    Europe, C.o. (2003) Recommendation Rec(2003)24 of the Committee of Ministers to member states on the organisation of palliative care and explanatory memorandum.Google Scholar
  11. 11.
    Frank A (1995) The wounded storyteller. The University of Chicago Press, ChicagoGoogle Scholar
  12. 12.
    Friberg F, Öhlén J (2007) Searching for knowledge and understanding while living with impending death—a phenomenological case study. Int J Qual Stud Health Well-Being 2(4):217–226. doi:10.1080/17482620701523777 CrossRefGoogle Scholar
  13. 13.
    Halimaa S-L (2001) Video recording as a method of data collection in nursing research. Vard Norden 21:21–26Google Scholar
  14. 14.
    Hancock K et al (2007) Truth-telling in discussing prognosis in advanced life-limiting illnesses: a systematic review. Palliat Med 21(6):507–517. doi:10.1177/0269216307080823 CrossRefPubMedGoogle Scholar
  15. 15.
    Hancock K et al (2007) Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage 34(2):190–200. doi:10.1016/j.jpainsymman.2006.11.009 CrossRefPubMedGoogle Scholar
  16. 16.
    Jarrett N, Payne SA (2000) Creating and maintaining ‘optimism’ in cancer care communication. Int J Nurs Stud 37:81–90. doi:10.1016/S0020-7489(99)00039-5 CrossRefPubMedGoogle Scholar
  17. 17.
    Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16:779–785. doi:10.1007/s00520-007-0396-7 CrossRefPubMedGoogle Scholar
  18. 18.
    Maguire P, Pitceathley C (2002) Key communication skills and how to acquire them. BMJ 325(7366):697–700. doi:10.1136/bmj.325.7366.697 CrossRefPubMedGoogle Scholar
  19. 19.
    Makoul G (2001) Essential elements of communication in medical encounters: the Kalamazoo Consensus Statement. Acad Med 76(4):390–393. doi:10.1097/00001888-200104000-00021 CrossRefPubMedGoogle Scholar
  20. 20.
    Mattingly C (1998) Healing dramas and clinical plots. The narrative structure of experience. Cambridge university press, CambridgeGoogle Scholar
  21. 21.
    Murinson BB, Aakash KA, Haythornthwaite JA (2008) Cognitive expertise, emotional development, and reflective capacity: clinical skills for improved care. J Pain 9(11):975–983. doi:10.1016/j.jpain.2008.07.010 CrossRefPubMedGoogle Scholar
  22. 22.
    O’Hair D (2003) Research traditions in provider–consumer interaction: implications for cancer care. Patient Educ Couns 50(1):5–8PubMedGoogle Scholar
  23. 23.
    Parker SM et al (2007) A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage 34(1):81–93. doi:10.1016/j.jpainsymman.2006.09.035 CrossRefPubMedGoogle Scholar
  24. 24.
    Polit DF, Beck CT (2004) Nursing research : principles and methods. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  25. 25.
    Potter J (2003) Discursive psychology: between method and paradigm. Discourse Soc 14:783–794. doi:10.1177/09579265030146005 CrossRefGoogle Scholar
  26. 26.
    Potter J, Wetherell M (1987) Discourse and social psychology. Beyond attitudes and behaviour. Sage, LondonGoogle Scholar
  27. 27.
    Rapley T et al (2006) Doctor–patient interaction in a randomised controlled trial of decision-support tools. Soc Sci Med 62(9):2267–2278. doi:10.1016/j.socscimed.2005.10.011 CrossRefPubMedGoogle Scholar
  28. 28.
    Roberts C, Sarangi S (2005) Theme-oriented discourse analysis of medical encounters. Med Educ 39:632–640. doi:10.1111/j.1365-2929.2005.02171.x CrossRefPubMedGoogle Scholar
  29. 29.
    Romanoff BD, Thompson BE (2006) Meaning construction in palliative care: the use of narrative, ritual, and the expressive arts. Am J Hosp Palliat Med 23(4):309–316CrossRefGoogle Scholar
  30. 30.
    Roter DL et al (2000) Experts practice what they preach. A descriptive study of best and normative practices in end-of-life discussions. Arch Intern Med 160(22):3477–3485. doi:10.1001/archinte.160.22.3477 CrossRefPubMedGoogle Scholar
  31. 31.
    Sarangi S, Roberts C (1999) The dynamics of interactional and institutional orders in work-related settings. In: Sarangi S, Roberts C (eds) Talk, work and institutional order Discourse in medical, mediation and management settings. Mouton de Gruyter, Berlin, pp 1–57CrossRefGoogle Scholar
  32. 32.
    Silverman D (2004) Interpreting qualitative data: methods for analyzing talk, text and interaction, 2nd edn. Sage, LondonGoogle Scholar
  33. 33.
    Whittemore R, Chase SK, Mandle CL (2001) Validity in qualitative research. Qual Health Res 11:522–537. doi:10.1177/104973201129119299 CrossRefPubMedGoogle Scholar
  34. 34.
    Öhlén J et al (2008) Exploration of communicative patterns of consultations in palliative cancer care. Eur J Oncol Nurs 12(1):44–52. doi:10.1016/j.ejon.2007.07.005 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Eva Lidén
    • 1
    • 2
  • Joakim Öhlén
    • 2
  • Lars-Christer Hydén
    • 3
  • Febe Friberg
    • 2
  1. 1.University College of Borås, School of Health SciencesBoråsSweden
  2. 2.Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care SciencesGothenburgSweden
  3. 3.Department of Medicine and Health SciencesLinköping UniversityLinköpingSweden

Personalised recommendations