Ways of talking about illness and prognosis in palliative cancer care consultations--two interactional frames.

ABSTRACT

GOALS OF WORK The purpose of the study was to describe how interaction about changes in illness and prognosis was shaped by participants in outpatient palliative cancer care consultations. PATIENTS AND METHODS: The data collection involved six video-recorded consultations at an outpatient oncology unit at a university hospital in Sweden. The interactions were studied by means of discourse analysis. Inclusion criteria for the patients were gastro-intestinal cancer and receiving palliative care. The sample included three men and three women, aged 54-70, with various metastasised gastro-intestinal tumours. Significant others (SOs) were included where patients brought one to the consultation. Three male consultants aged 55-59 participated. MAIN RESULTS: In palliative care consultations, the person-to-person and the patient-professional conversation frames were found to be in use as patients, SOs and physicians talked about the patients' illness and prognosis. Within the patient-professional frame, three interactional patterns were found the patient emphasising emotional experiences of illness or well-being and the physicians responding by toning down strategies, patients asking direct questions and getting straight answers and finally interaction marked by cautiousness and avoidances. Within the person-person frame, the interactions were described as playful talk, collegial talk and existential talk. CONCLUSIONS: When patients shared their personal interpretations of illness and prognosis, their narrative was more enhanced by the person-to-person frame than the patient-professional frame. Finding out if and how patients and SOs want to express their worries and finding a balance between the interactional patterns that occur are ethical challenges which health professionals must face. Since patients and SOs may restrain their emotional experiences, investigating grounded ways of overcoming these difficulties is imperative.