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Qualitative analysis of expressions used in the end-of-life discussions and their associated factors

Published online by Cambridge University Press:  11 October 2023

Akiko Abe Open the ORCID record for Akiko Abe [Opens in a new window] ,
Mari Takeuchi ,
Masato Kobayashi ,
Takashi Kohno ,
Masaru Mimura  and
Daisuke Fujisawa
Akiko Abe*
Affiliation:
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
Mari Takeuchi
Affiliation:
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan Palliative Care Center, Keio University School of Medicine, Tokyo, Japan
Masato Kobayashi
Affiliation:
Keio University School of Medicine, Tokyo, Japan
Takashi Kohno
Affiliation:
Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo, Japan
Masaru Mimura
Affiliation:
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Daisuke Fujisawa
Affiliation:
Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan Palliative Care Center, Keio University School of Medicine, Tokyo, Japan Division of Patient Safety, Keio University Hospital, Tokyo, Japan
*
Corresponding author: Akiko Abe; Email: akiko.abe@keio.jp
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Abstract

Objectives

Discussing end-of-life (EOL) issues with patients remains challenging for health professionals. Physicians may use various expressions, including euphemistic ones, when disclosing the prognosis to their patients to reduce their psychological impact. However, the actual expressions of EOL disclosure in clinical practice are unclear. This study aims to investigate the expressions used in EOL disclosures and explore their associated factors.

Methods

A retrospective chart review was conducted enrolling all the patients who died in a university-affiliated hospital. Expressions used in the EOL disclosure were qualitatively analyzed. The patients’ participation rate and length from the discussion to death were investigated.

Results

EOL disclosures were observed in 341 of 358 patients. The expressions used by the physicians were categorized into 4 groups; Group 1: Clear presentation of life expectancy (n = 106; 31.1%), Group 2: Euphemistic presentation of life expectancy (n = 24; 7.0%), Group 3: Presentation of risk of sudden death (n = 147; 43.1%), Group 4: No mention on life expectancy (n = 64; 18.8%). The proportion of male patients was higher in Group 2 (79%) and lower in Group 4 (56%). Patients with cancer accounted for approximately 70% of Groups 1 and 4, but only approximately 30% of Group 3. The patient participation rate was highest in Group4 (84.4%), followed by Group 2 (50.0%). The median time from EOL disclosure to death was longer in Groups 1 and 4 (26 and 29.5 days, respectively), compared to Groups 2 and 3 (18.5 and 16 days, respectively).

Significance of results

A variety of expressions are used in EOL disclosure. Patterns of communication are influenced by patients’ gender and type of illness (cancer or noncancer). Euphemisms do not seem to facilitate timely disclosure of life expectancy or patient participation. For health professionals, not only devising the expressions to alleviate their patients’ distress when breaking bad news but also considering the communication process and patient background are essential.

Keywords

End-of-life discussionAdvance care planningCommunicationPrognosis
Type
Original Article
Information
Palliative & Supportive Care , Volume 22 , Issue 2 , April 2024 , pp. 374 - 380
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Copyright
© The Author(s), 2023. Published by Cambridge University Press.

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