End-of-life communication training

Background: When patients are likely to die in the coming hours or days, families often want prognostic information. Prognostic uncertainty and a lack of end-of-life communication training make these conversations challenging. Aim: The objective of this study is to understand how clinicians and the relatives/friends of patients at the very end of life manage uncertainty and reference time in prognostic conversations. Design: Conversation analysis of audio-recorded conversations between clinicians and the relatives/friends of hospice inpatients. Setting/participants: Experienced palliative care clinicians and relatives/friends of imminently dying hospice inpatients. Twenty-three recorded conversations involved prognostic talk and were included in the analysis. Results: Requests for prognostic information were initiated by families in the majority of conversations. Clinicians responded using categorical time references such as ‘days’, allowing the provision of prognostic estimates without giving a precise time. Explicit terms such as ‘dying’ were rare during prognostic discussions. Instead, references to time were understood as relating to prognosis. Relatives displayed their awareness of prognostic uncertainty when requesting prognostic information, providing clinicians with ‘permission’ to be uncertain. In response, clinicians often stated their uncertainty explicitly, but presented evidence for their prognostic estimates, based on changes to the patient’s function previously discussed with the family. Conclusion: Prognostic uncertainty was managed collaboratively by clinicians and families. Clinicians were able to provide prognostic estimates while being honest about the related uncertainty, in part because relatives displayed their awareness of uncertainty within their requests. The conversation analytic method identified contributions of both clinicians and families, and identified strategies based on real interactions, which could inform communication training.

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Dipping the Paddle in Unfamiliar Waters: The Ripple Effects of the First End-of-Life Communication Training for Resource Poor, Multicultural, Underdeveloped Island Nations of the United States–Affiliated Pacific Islands (USAPIs) (S771)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.12.332 ◽

2020 ◽

Vol 59 (2) ◽

pp. 569-570

Author(s):

Dawn Gross

Keyword(s):

United States ◽

End Of Life ◽

Pacific Islands ◽

The United States ◽

Communication Training ◽

Ripple Effects ◽

Resource Poor ◽

End Of Life Communication

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A communication training perspective on AND versus DNR directives

Palliative & Supportive Care ◽

10.1017/s147895151400039x ◽

2014 ◽

Vol 13 (2) ◽

pp. 385-387 ◽

Cited By ~ 5

Author(s):

Tomer T. Levin ◽

Nessa Coyle

Keyword(s):

Palliative Care ◽

End Of Life ◽

Communication Training ◽

Do Not Resuscitate ◽

Natural Death ◽

Goals Of Care ◽

Advantages And Disadvantages ◽

Randomized Controlled ◽

Unnatural Death ◽

End Of Life Communication

AbstractBackground:From a communication perspective, the term “do not resuscitate” (DNR) is challenging to use in end-of-life discussions because it omits the goals of care. An alternative, “Allow Natural Death” (AND), has been proposed as a better way of framing this palliative care discussion.Case:We present a case where a nurse unsuccessfully discusses end-of-life goals of care using the term DNR. Subsequently, with the aid of a communication trainer, he is coached to successfully use the term “AND” to facilitate this discussion and advance his goal of palliative care communication and planning.Discussion:We contrast the advantages and disadvantages of the term AND from the communication training perspective and suggest that AND-framing language replace DNR as a better way to facilitate meaningful end-of-life communication. One well-designed, randomized, controlled simulation study supports this practice. We also consider the communication implications of “natural” versus “unnatural” death.

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Psychometric analysis of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument

International Journal of Palliative Nursing ◽

10.12968/ijpn.2020.26.8.404 ◽

2020 ◽

Vol 26 (8) ◽

pp. 404-412

Author(s):

Mary E Minton ◽

Mary J Isaacson ◽

Patricia Da Rosa

Keyword(s):

End Of Life ◽

Content Validity ◽

End Of Life Care ◽

Life Care ◽

Validity Index ◽

Retest Reliability ◽

Five Factors ◽

Instrument Measuring ◽

Test Retest Reliability ◽

End Of Life Communication

Background: Nurses must be comfortable facilitating palliative and end-of-life communication with patients and their families. Aim: A validated instrument measuring the comfort of nurses with conducting end-of-life communication is essential for meeting the goals and wishes of patient care. This study aimed to develop and conduct a psychometric evaluation of the Comfort with Communication in Palliative and End-of-Life Care (C-COPE) instrument. Methods: Face, content, and construct validity, including test-retest reliability, were conducted. Results: Four experts subjectively confirmed face content validity and the quantitative item content validity index (I-CVI) ranged from 0.67 to 1 and scale content validity index (S-CVI/Ave) was 0.98. Principal axis factoring with Promax rotation yielded a five-factor solution accounting for 66.2% of the variance. The items loading on the five factors ranged from 0.46–0.96 (factor 1), 0.67–0.93 (factor 2), 0.49–0.86 (factor 3), 0.68–0.79 (factor 4), and 0.24–0.96 (factor 5). Internal consistency reliability (coefficient a) was 0.90 for the total C-COPE, and above 0.75 for each factor. The five factors are ‘cultural/spiritual considerations,’ ‘team considerations,’ ‘addressing decision-making,’ ‘addressing symptomatology,’ and ‘deliberate awareness.’ Test-retest reliability yielded an intraclass correlation coefficient (ICC) of 0.87 (CI 95%, 0.82–0.91). Conclusions: The C-COPE is a reliable and valid instrument measuring nurse comfort with palliative and end of-life care communication, yet requires testing in more diverse samples.

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