Navigating Prognostic Dialogue During Serious Illness Conversations

How do patients, caregivers, and hematology clinicians trained in serious illness conversations navigate prognostic dialogue?In this qualitative study of 25 transcripts of serious illness conversations, patients and caregivers oscillated in their readiness to engage in prognostic dialogue, whereas clinicians responded with attentiveness and flexibility. Prognostic uncertainty served as a conversational resource, enabling clinicians to balance hope and realism and sustain dialogue.These findings suggest that hematology clinicians can be trained in communication skills that promote attentiveness and responsiveness to patients’ fluctuating readiness and prognostic uncertainty, thereby supporting double awareness (living meaningfully while preparing for the end of life).

Corresponding Author: Cæcilie Borregaard Myrhøj, RN, MScN, PhD, Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark, [street address here] (caecilie.borregaard.myrhoej@regionh.dk).

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