The contagion of optimism: The relationship between patient optimism and palliative care clinician overestimation of survival among hospitalized patients with advanced cancer

Ingersoll, Luke T; Alexander, Stewart C.; Ladwig, Susan; Anderson, Wendy G.; Norton, Sally A.; Gramling, Robert

doi:10.1002/pon.5080

Cited by 13 publications

(7 citation statements)

References 35 publications

(49 reference statements)

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“…It is possible that due to the unpredictability of COVID-19, health and social care professionals did not expect death would be so imminent and there would be 'more time'. 36,37 Alongside this, the government restrictions of visiting at end of life in institutional settings as a result of COVID-19 may have presented health and social care professionals with a dilemma of balancing the importance of relatives wanting to be with their dying family member and the unpredictability as to when is the time to enable this to happen. Families cope better long-term when they have an opportunity to say goodbye to their dying family member 18,38 ; this indicates that health and social care professionals should consider offering a family visit at an earlier opportunity, rather than waiting until death is expected within hours or days.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study of bereaved relatives’ end of life experiences during the COVID-19 pandemic

et al. 2021

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Background: Meeting the needs of relatives when a family member is dying can help facilitate better psychological adjustment in their grief. However, end of life experiences for families are likely to have been deleteriously impacted by the COVID-19 crisis. Understanding how families’ needs can be met during a global pandemic will have current/future relevance for clinical practice and policy. Aim: To explore relatives’ experiences and needs when a family member was dying during the COVID-19 pandemic. Design: Interpretative qualitative study using semi-structured interviews. Data were analysed thematically. Setting/participants: A total of 19 relatives whose family member died during the COVID-19 pandemic in the United Kingdom. Results: In the absence of direct physical contact, it was important for families to have a clear understanding of their family member’s condition and declining health, stay connected with them in the final weeks/days of life and have the opportunity for a final contact before they died. Health and social care professionals were instrumental to providing these aspects of care, but faced practical challenges in achieving these. Results are presented within three themes: (1) entering into the final weeks and days of life during a pandemic, (2) navigating the final weeks of life during a pandemic and (3) the importance of ‘saying goodbye’ in a pandemic. Conclusions: Health and social care professionals can have an important role in mitigating the absence of relatives’ visits at end of life during a pandemic. Strategies include prioritising virtual connectedness and creating alternative opportunities for relatives to ‘say goodbye’.

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Section: Discussionmentioning

confidence: 99%

A qualitative study of bereaved relatives’ end of life experiences during the COVID-19 pandemic

et al. 2021

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“…There are multiple barriers to timely hospice referral. These include short visit time, overly optimistic prognostication, and status quo bias [29,30]. The observed bene t of PC consultation with respect to hospice enrollment in this study is likely related to the close integration of PC and hospice services and the signi cant overlap in philosophy of care between PC and hospice.…”

Section: Discussionmentioning

confidence: 81%

End-of-life outcomes of advanced cancer patients enrolled in palliative care

Lynch,

Lyon,

Ramalingam

et al. 2023

Preprint

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PURPOSE: We sought to understand how Palliative Care (PC) enrollment differs between patient demographics and whether enrollment affects end of life (EOL) outcomes in an integrated system. METHODS: This retrospective cohort study included Stage IV solid cancer patients who died within 1 year of diagnosis within Kaiser Permanente Northern California between 1/1/2018-12/31/2020. Demographics and EOL outcomes were compared by PC enrollment. Categorical and continuous comparisons were made using Pearson’s χ2 and Wilcoxon Rank Sum tests. Logistic regression was performed to assess independent predictors of EOL outcomes. RESULTS: Among 3,575 patients, 45.1% enrolled in PC. Age and comorbidities (p < 0.01) differed between groups; race (p = 0.32) and socioeconomic status (p = 0.54) did not. PC was associated with lower odds of hospitalization (OR 0.62, CI 0.54–0.72) and ICU admission (OR 0.30, CI 0.32–0.50) in the last 30 days of life (DOL) and higher odds of hospice enrollment (OR 2.12, CI 1.81–2.41). More PC visits correlated with more hospice enrollment (49.2% 4 + PC visits, 43.6% 2–3 visits, and 39.9% 1 visit, p = 0.01) and less hospitalization in the last 30 DOL (33.5% vs. 34.4% vs. 45.4%, p < 0.01). Patients in PC had shorter hospital stays (4.0 days vs. 5.0 days, p < 0.01). CONCLUSION: There was improvement in EOL outcomes for patients in PC in their last year of life, with greater improvements as PC visits increased. No racial/ethnic or socioeconomic disparities were observed in enrollment.

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“…The speaker during each transcribed turn was tagged as either from the patient side of the conversation (which could include family members and/or close friends who were present in support of the patient) or a clinician, except in rare occasions (<1% of turns) when transcribers could not determine whether the speaker was from the patient side or the clinician side. All speaker turns in which the patient was audibly perceived to be expressing anger or fear were subsequently labeled in the PCCRI transcripts, using well-established and reliable human coding methods [56,57]. Anger was defined to include expressions of either frustration or anger.…”

Section: The Pccri Corpusmentioning

confidence: 99%

A general model of conversational dynamics and an example application in serious illness communication

et al. 2021

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Conversation has been a primary means for the exchange of information since ancient times. Understanding patterns of information flow in conversations is a critical step in assessing and improving communication quality. In this paper, we describe COnversational DYnamics Model (CODYM) analysis, a novel approach for studying patterns of information flow in conversations. CODYMs are Markov Models that capture sequential dependencies in the lengths of speaker turns. The proposed method is automated and scalable, and preserves the privacy of the conversational participants. The primary function of CODYM analysis is to quantify and visualize patterns of information flow, concisely summarized over sequential turns from one or more conversations. Our approach is general and complements existing methods, providing a new tool for use in the analysis of any type of conversation. As an important first application, we demonstrate the model on transcribed conversations between palliative care clinicians and seriously ill patients. These conversations are dynamic and complex, taking place amidst heavy emotions, and include difficult topics such as end-of-life preferences and patient values. We use CODYMs to identify normative patterns of information flow in serious illness conversations, show how these normative patterns change over the course of the conversations, and show how they differ in conversations where the patient does or doesn’t audibly express anger or fear. Potential applications of CODYMs range from assessment and training of effective healthcare communication to comparing conversational dynamics across languages, cultures, and contexts with the prospect of identifying universal similarities and unique “fingerprints” of information flow.

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The contagion of optimism: The relationship between patient optimism and palliative care clinician overestimation of survival among hospitalized patients with advanced cancer

Cited by 13 publications

References 35 publications

A qualitative study of bereaved relatives’ end of life experiences during the COVID-19 pandemic

A qualitative study of bereaved relatives’ end of life experiences during the COVID-19 pandemic

End-of-life outcomes of advanced cancer patients enrolled in palliative care

A general model of conversational dynamics and an example application in serious illness communication

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