Research Report
Palliative Care Communication: Linking Patients' Prognoses, Values, and Goals of Care
Sally A. Norton,
Maureen Metzger,
Jane DeLuca,
Stewart C. Alexander,
Timothy E. Quill,
Robert Gramling,
Corresponding Author
Sally A. Norton
School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642
Associate Professor.Correspondence to: Sally A. NortonSearch for more papers by this authorMaureen Metzger
School of Nursing, University of North Carolina, Wilmington, NC
Postdoctoral Fellow.Search for more papers by this authorJane DeLuca
School of Nursing, Clemson University, Clemson, SC
Assistant Professor.Search for more papers by this authorStewart C. Alexander
Department of Medicine, School of Medicine, Duke University, Durham, NC
Associate Professor.Search for more papers by this authorTimothy E. Quill
Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
Professor.Search for more papers by this authorRobert Gramling
Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
Associate Professor.Search for more papers by this authorSally A. Norton,
Maureen Metzger,
Jane DeLuca,
Stewart C. Alexander,
Timothy E. Quill,
Robert Gramling,
Corresponding Author
Sally A. Norton
School of Nursing, University of Rochester, 601 Elmwood Avenue, Box SON, Rochester, NY, 14642
Associate Professor.Correspondence to: Sally A. NortonSearch for more papers by this authorMaureen Metzger
School of Nursing, University of North Carolina, Wilmington, NC
Postdoctoral Fellow.Search for more papers by this authorJane DeLuca
School of Nursing, Clemson University, Clemson, SC
Assistant Professor.Search for more papers by this authorStewart C. Alexander
Department of Medicine, School of Medicine, Duke University, Durham, NC
Associate Professor.Search for more papers by this authorTimothy E. Quill
Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
Professor.Search for more papers by this authorRobert Gramling
Department of Family Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY
Associate Professor.Search for more papers by this authorGreenwall/Kornfeld Foundation Research Grant (Gramling, Norton, Alexander), National Palliative Care Research Center Career Development Award (Gramling), and a Ruth L. Kirchstein National Research Service Award, Fellowship 1F31 NR012084-01 (Metzger). Appreciation to Susan Ladwig and to the patients, family members, and clinicians who participated in this study.
Abstract
Prognostic communication is a primary component of goals of care conversations in palliative care (PC) practice. Little is known about these conversations in the natural setting. This study's aim was to describe the processes of prognostic communication in PC goals of care consultations. Using line-by-line qualitative analysis, we examined prognostic conversation in 66 audio-taped PC consultations. We identified five processes by which clinicians link prognoses, values, and goals of care: (1) signposting the crossroads; (2) closing off a goal; (3) clarifying current path; (4) linking paths and patients' values; and (5) choosing among paths. The findings add to our understanding of PC consultation by describing how prognoses link with patients' values and choices in goals of care conversations. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36: 582–590, 2013
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