Early palliative care integration trial: consultation content and interaction dynamics.

Kleiner, Nadine; Zambrano, Sofia C.; Eychmüller, Steffen; Zwahlen, Susanne (2021). Early palliative care integration trial: consultation content and interaction dynamics. (In Press). BMJ supportive & palliative care BMJ Publishing Group 10.1136/bmjspcare-2020-002419

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OBJECTIVES

Evidence for the positive impact of the early integration of palliative care (EPC) continues to grow. Less is known about how EPC improves patient and family outcomes, including the content of EPC consultations. Therefore, we aimed to better understand the content of EPC consultations including areas addressed, percentage covered per area and interaction style.

METHODS

As part of a trial in which EPC in addition to oncology care was compared with oncology care alone, we audio recorded 10 interventions. The palliative care team led the interventions using SENS, a conversation structure, which stands for: Symptoms, End-of-life decision-making, Network and Support. We employed two approaches to analysis: the Roter interaction analysis system (RIAS) to analyse interaction dynamics and SENS as a framework for content analysis.

RESULTS

Physician-patient communication covered 91% of the interaction. According to RIAS, the consultations were evenly dominated between physicians and patients (ratio=1.04) and highly patient-centred (ratio=1.26). Content wise, rapport was the largest category covering 27% of the consultation, followed by decision-making (21%) and by symptom assessment/management (17%) including 8.1% for physical symptoms and 5.4% for psychosocial aspects. Network discussions covered 17%, and lastly, support for the family 7%.

CONCLUSIONS

EPC consultations cover a variety of end-of-life topics while putting a high value in establishing rapport, developing a relationship with patients, and on providing reassurance and positive emotional talk. EPC consultations using predefined structures may guarantee that a minimum of important aspects are addressed in a way in which the relationship with the patient remains at the centre.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

UniBE Contributor:

Zambrano Ramos, Sofia Carolina; Eychmüller, Steffen and Zwahlen, Susanne

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2045-4368

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Rebeka Gerber

Date Deposited:

24 Sep 2021 11:24

Last Modified:

24 Sep 2021 11:24

Publisher DOI:

10.1136/bmjspcare-2020-002419

PubMed ID:

33419859

Uncontrolled Keywords:

cancer communication prognosis quality of life supportive care symptoms and symptom management

URI:

https://boris.unibe.ch/id/eprint/159165

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