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P-77 Earlier conversations about the future: healthcare professionals broaching hospice care and other end-of-life issues
  1. Victoria Land1,
  2. Rose McCabe1 and
  3. Ann Rhys2
  1. 1City, University of London, London, UK
  2. 2Hospiscare, Exeter, UK


Background Early conversations about the future benefits people with life-limiting conditions. Timely admission to a hospice service often provides the best outcomes (Brighton & Bristowe. Postgrad Med J. 2016; 92(1090): 466–470). However, patients are frequently not referred until near to death (Casarett & Quill. Ann Intern Med. 2007; 146(6): 443–449): ‘at the beginning of the end.’ There are multiple reasons for this. Healthcare practitioners (HCPs) may not want to relinquish their patients or to acknowledge that they cannot intervene to prolong the patient’s life further. Meanwhile, patients and families who received hospice care would have liked to have more information about the hospice when the illness was labelled terminal (Weckmann, Family Practice Manage. 2008; 18–22.). There are often negative connotations associated with the word ‘hospice’ (Friedman, Harwood, Shields. J Palliat Med. 2002; 5(1):73–84; Matthews, Peters, Lawson. Health Mark Q. 2017l; 34(1): 48–61) which feeds into practitioners’ reluctance to bring up the subject. We address these challenges by focusing on approaches and ‘what words to use’ when broaching conversations about referral to a hospice.

Aim Our aim is to explore the language used by HCPs who refer to a hospice service and the challenges in making earlier referrals. We identify specific language practices for encouraging these conversations.

Method We are interviewing HCPs (N=25) who talk to patients with life-limiting conditions and their family members about planning for the future, including referrals to a hospice. These HCPs include hospital consultants, GPs, occupational therapists, nurses and psychiatrists. Interviews are subjected to inductive thematic analysis based on six principles developed by Braun and Clarke (2006). Analysis is assisted by NVivo data analytic software.

Results/conclusions Our study is in progress. So far, thematic analysis has identified key signs of patient readiness for conversations, techniques for encouraging patient engagement (e.g., hypotheticals, framing around control), specific language and conversational approaches for starting a dialogue, ways into broaching these conversations through checking existing patient understanding, ideal timings for beginning these discussions, and supporting HCPs’ confidence in having these conversations through training.

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