Establishing Terminal Status in End-of-Life Discussions

Abstract

The communicative purpose of an end-of-life discussion is to change the goals of treatment for a terminal patient from therapeutic to comfort care. In this study, the authors present a comparative discourse analysis of end-of-life discussions that reached a consensus to change the goals of treatment and discussions that did not. They found that the presentation of medical information was subtly different across these discussions: Decision-making discussions were based on a consistent accumulation of negative evidence, whereas non-decision-making discussions were inconsistent in this respect, including mention of positive rather than negative outcomes of medical problems, discussion of possible treatment options, and mitigating summary statements. The authors note that end-of-life discussions with these specific features do not progress to a decision to change the goals of treatment to comfort care.

Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence

“…The first theme identified was highlighting deterioration, which was found in 11 papers. 26,30–32,35,36,39,54,55,58,59 This describes how healthcare professionals enabled relatives to recognize the patient’s deterioration (referred to as ‘establishing terminal status’ by one study 30 ). Highlighting deterioration involved listing the patient’s previous and ongoing problems to provide evidence that further active treatment was futile and the patient was reaching the end-of-life.…”

“…In these conversations, a consensus on terminal status was less likely to be reached and decisions relating to withdrawal of treatment were made less often. 30…”

“…44,45,48 In observational studies, healthcare professionals’ language varied in its level of directness. 30,31,33,40,42,48 In interviews, they highlighted the difficult balance between being honest and allowing families hope, mostly emphasizing the need to avoid false hope and be honest to build trust with families. 49,50,52,54,56 However, nurses reported that doctors sometimes felt the need to ‘try everything’ and this could lead to false hope for families and unnecessary, aggressive treatments for patients.…”

Linguistic Analysis of Face‐to‐Face Interviews with Patients with An Explicit Request for Euthanasia, their Closest Relatives, and their Attending Physicians: the Use of Modal Verbs in Dutch

“…None of the 72 articles we collected have clear indications in either the abstract or the discussion and conclusion section of the use of linguistic parameters in analyzing the material. Some articles do claim that they use a discourse analytical method or a qualitative content analysis …”

Contornos negociados del "buen morir": la toma de decisiones médicas en el final de la vida

“…en servicios de cuidados intensivos los profesionales desarrollan estrategias interaccionales para compartir y avalar las decisiones de suspender los tratamientos que sostienen artificialmente con vida a los pacientes (Aldrige, Barton, 2007;DelVecchio Good et al, 2004;Seymour, 2000;Harvey, 1997).…”