Early palliative care integration trial: consultation content and interaction dynamics

Abstract

ObjectivesEvidence 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.MethodsAs 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.ResultsPhysician–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%.ConclusionsEPC 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.

Acceptance and Benefits of Two Different Strategies to Timely Integrate Specialist Palliative Care into Routine Cancer Care: A Randomized Pilot Study

“…Content analysis of SPC counselling identified symptoms, rapport, coping, illness understanding, and advance care planning as relevant themes in early SPC counselling, corresponding with previous data from the group of Temel et al[32] as well as with a recent study of Kleiner et al [35]. Two themes, symptoms and advance care planning, corresponded strongly with the predefined conversation structure for SPC counselling (online suppl.…”

“…On the other hand, it remains unclear what really is the individually optimal time point for “timely” first SPC counselling in cancer patients across entities and differing prognoses, as well as the optimal contents of this first consultation [30, 33, 34]. It has been shown that such consultations cover a broad spectrum of end-of-life topics, centering around establishing rapport, developing a relationship with patients, and providing reassurance and positive conversations on emotional aspects [35].…”

The early integration of palliative care into oncology care: A rapid review

“…The analysis of the five RCTs did not reveal much about the favourable components of EPC interventions. Only Bakitas et al (2015) and Vanbutsele et al (2018) Kleiner et al (2021), additional studies would be useful in formally defining the structure and components of an EPC intervention. The findings of this rapid review were shared with oncology nurses as part of a PowerPoint presentation.…”

Changes in Cancer Patients' and Caregivers' Disease Perceptions While Receiving Early Palliative Care: A Qualitative and Quantitative Analysis

“…When talking about their present, our participants were able to list positive aspects of their experience. Thus, being able to see things in a positive light might be a critical benefit of having a relationship with the EPC team [ 45 ]. Consistently, once symptoms were lessened, there was a significant increase in the use of Insight Thinking and Agency words.…”

“…Agency words may reflect intentional causation, degree of autonomy, and manner of autonomy [ 46 , 47 ]. Insight Thinking words have been associated with a drop in intrusive thinking about negative events [ 44 ] and are often observed together with Positive Affects words, representing a positive reappraisal of events that requires cognitive broadening [ 45 ].…”