Abstract
1.Describe the existential concerns individuals may express during palliative care conversations involving prognosis.2.Describe how existential communication and prognosis communication interrelate in palliative care conversations. Communication about prognosis is a key ingredient of effective palliative care. Prognosis communication may prompt contemplation of one’s suffering and death, and therefore trigger existential questions; however, the existential dimensions of prognosis communication are underexplored. To describe the existential dimensions of prognosis communication in palliative care conversations in the natural setting. We used a mixed methods approach to analyze a random subset of participants from the Palliative Care Communication Research Initiative (PCCRI) parent study. The PCCRI was a multisite observational cohort study involving hospitalized adults with advanced cancer who were referred for inpatient palliative care consultations. The unique dataset includes 231 patients, contributing to 363 recorded conversations. The present study stratified a subset of conversations derived from the PCCRI study by level of prognosis communication, and qualitatively described existential dimensions of conversations within and across none, low, and high levels of prognosis communication. Our sample included 34 participants from the parent PCCRI study, contributing to 45 palliative care conversations. There were no prominent differences in patient-level characteristics by prognosis communication level, including on measures of disease severity (i.e. PPS and time to death). Mixed analyses revealed three key findings. We found existential and prognosis communication were deeply interconnected. Additionally, existential communication was more common within conversations with higher levels of prognosis communication. This represented an existential shift compared to the more physical focus of conversations with no prognosis communication. Existential communication and prognosis communication are intimately linked within palliative care conversations.
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