Communication in Palliative Care and About End of Life: A State-of-the-Art Literature Review of Conversation-Analytic Research in Healthcare

Abstract

ABSTRACT I review conversation analytic research on healthcare interactions in palliative care, and end-of-life preferences and plans conversations in other settings. The review process drew on established systematic review methods. Twenty-two publications were included. Key themes were initiating and managing the topics of dying, of prognosis, and of advance care planning, and interactionally managing emotions. There is substantial, cumulative evidence about patterns and practices for initiating sensitive conversations, managing emotions, and indirectly referring to death. Two of 22 studies examined interactional consequences of companions accompanying patients, and two examined pain assessment. Current evidence is restricted: 21 of 22 studies were in secondary/tertiary care and all were in high-income countries, and most involved specialist physicians. Nevertheless, findings contribute to conversation analytic scholarship on delicacy, emotion in interaction, and indirect reference. Healthcare applications include contributions to training in communicating about sensitive topics and to policy on talking about dying. Data presented are in British English, U.S. English, Canadian English, Swiss-French, and Japanese.