Does Disclosure of Terminal Prognoses Mean Losing Hope? Patient Perspectives on Palliative Care Consultations (S717)

Abstract

1.Discuss the impact of inpatient palliative care consultations on patients’ hope.2.Describe patient experiences with inpatient palliative care consultations.3.Discuss the impact of inpatient palliative care consultations on meeting patients’ end-of-life care preferences. Fear of the patient losing hope or the patient believing that the physician is giving up hope serves as a barrier for physicians to disclose a terminal prognosis with seriously ill patients. Palliative care consultations have been developed to discuss prognoses and address the health needs of these patients, but little is known about the patient perspective and experience of the palliative care consultation. To elicit the perspectives of hospitalized, seriously ill patients following an inpatient palliative care (IPC) consultation and explore the impact of patient attitudes toward information derived from the consultation. A qualitative study using individual interviews with seriously ill patients following an IPC consultation was performed within a large medical center serving a multiethnic population. A semi-structured interview protocol was employed. Twelve patients were interviewed during their hospitalization. Primary themes from the interviews pertained to the palliative care discussion, the consultation team, and the patient's emotions and mentality. Participants identified knowledge acquisition (of care options and supportive services), comprehensiveness of care, and the quality of the palliative care team as positive factors associated with the IPC consult. Patient emotions and psychosocial issues commonly addressed in the IPC consults were denial, reduced fear, gaining hope and motivation, and spiritual support, among others. Qualitative analyses support the role of IPC consults in addressing the physical, psychological, and spiritual health of hospitalized, seriously ill patients. The theme of “hope” that emerged from the IPC consult experience highlights that for some patients, gaining information about their terminal diagnosis and disease trajectory may increase hope rather than reduce it.