Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying

Marco Pino, Ruth Parry, Victoria Christine Land, Christina Faull, Luke Feathers, Jane Seymour

Research output: Contribution to journalArticlepeer-review


To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL)
talk. To examine whether the practice of “eliciting and responding to cues”, which has been
widely advocated in the EoL care literature, promotes EoL talk.

Conversation analysis of video- and audio-recorded consultations.

Unselected terminally ill patients and their companions in consultation with experienced palliative
medicine doctors.

Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice.

Doctors most commonly promoted EoL talk through open elaboration solicitations; these
created opportunities for patients to introduce–then later further articulate–EoL considerations
in such a way that doctors did not overtly ask about EoL matters. Importantly, the
wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a
patient responded to open elaboration solicitations without introducing EoL considerations,
doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive
type of solicitation, which suggested the patient might have EoL concerns. These more
overt solicitations were used only later in consultations, which indicates that doctors give
precedence to patients volunteering EoL considerations, and offer them opportunities to
take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of
patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations
associated with labelling that talk as “cues” as is common in EoL communication
contexts. We examine these limitations and propose “possible EoL considerations” as a
descriptively more accurate term.

Through communicating–via open elaboration solicitations–in ways that create opportunities
for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting
EoL talk: giving patients opportunities to choose whether to engage in conversations
about EoL whilst being sensitive to their communication needs, preferences and state of
readiness for such dialogue.
Original languageEnglish
Number of pages18
JournalPLoS ONE
Issue number5
Publication statusPublished - 31 May 2016

Bibliographical note

© 2016 Pino et al.

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