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Early palliative care integration trial: consultation content and interaction dynamics
  1. Nadine Kleiner,
  2. Sofia C. Zambrano,
  3. Steffen Eychmüller and
  4. Susanne Zwahlen
  1. University Centre for Palliative Care, Oncology Department, Inselspital University Hospital Bern, Bern, Switzerland
  1. Correspondence to Dr Sofia C. Zambrano, University Centre for Palliative Care, Inselspital University Hospital Bern, Bern 3010, Switzerland; sofia.zambrano{at}extern.insel.ch

Abstract

Objectives Evidence 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.

Methods As 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.

Results Physician–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%.

Conclusions EPC 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.

  • cancer
  • communication
  • supportive care
  • symptoms and symptom management
  • quality of life
  • prognosis
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Footnotes

  • NK and SCZ are joint first authors.

  • SE and SZ are joint senior authors.

  • Contributors SCZ, SZ and SE made substantial contributions to the conception and design of the work, SZ and SE contributed to data acquisition, NK, SCZ and SZ contributed to the analysis and interpretation of data for the work. NK and SCZ drafted the work. NK, SCZ, SZ and SE revised the content critically for important intellectual content. All coauthors provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was funded by the Swiss National Science Foundation (grant number: 145088).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received prospective ethical approval (KEK-Nr. 102/13).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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