Communicating with patients and families about difficult matters: A rapid review in the context of the COVID-19 pandemic

  1. Stuart Ekberg
  2. Ruth Parry
  3. Victoria Land
  4. Katie Ekberg
  5. Marco Pino
  6. Charles Antaki

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Abstract

Pandemics pose significant challenges for healthcare systems, including an increase in difficult discussions about future illness progression and end of life.

Objectives

To synthesise existing evidence about communication practices used to discuss difficult matters, including prognosis and end of life, and to use this evidence to make recommendations for clinical practice. The aim of this study was to use rapid review methods to update findings from a previous systematic review published in 2014.

Data sources

MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science, Scopus, ASSIA and Amed.

Study eligibility criteria

Studies using conversation analysis or discourse analysis to examine recordings of actual conversations about difficult matters relating to future illness progression and end of life.

Study appraisal and synthesis methods

Data appraisal and extraction procedures used in the 2014 review were modified for this rapid review.

Results

Following screening, 18 sources were deemed to meet eligibility criteria, which were added to the 19 sources included in the 2014 systematic review. Synthesis of study findings identified 11 communication practices: providing opportunities for patient or family members to propose matters to discuss (7 out of 37 included sources); seeking a patient or family member’s perspective (6/37); discussing the future indirectly (11/37); discussing the future explicitly (7/37) linking to something previously said or done (11/37); using hypothetical scenarios (13/37); framing a difficult matter as universal (5/37); acknowledging uncertainty (3/37); exploring options (2/37); displaying sensitivity (7/37); emphasising the positive (7/37).

Limitations

Dividing work amongst the study authors to enable rapid review may have created inconsistencies.

Conclusions and implications of key findings

This synthesis of high-quality evidence from actual clinical practice supports a series of recommendations for communicating about difficult matters during and beyond the COVID-19 pandemic.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2020.04.27.20078048: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The same databases used in the 2014 systematic review were searched for this rapid review: MEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science, and Scopus were searched by one reviewer (SE), ASSIA and Amed by another (VL).
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    EMBASE
    suggested: (EMBASE, RRID:SCR_001650)
    PsycINFO
    suggested: (PsycINFO, RRID:SCR_014799)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The rapid review methodology adopted for this study means there may be limitations to its findings. For instance, dividing work on the quality assessment and data extraction phases of the review amongst the review team may have introduced inconsistencies in work. In particular, this could have inhibited scope to identify and document similar findings across studies, thus preventing these being incorporated within the subsequent data synthesis phase. For this reason, this review updates but does not replace a systematic review conducted in 2014,19 which had greater scope to systematically review and synthesise findings than was likely to have been the case in the current study. Considerable progress has been made in developing high-quality evidence to inform difficult conversations about illness progression and end of life. Research based on direct and detailed analysis of real life difficult discussions that have been audio- or video-recorded has almost doubled since a systematic review was published in 2014.19 Nevertheless, further research is likely to yield additional insights into the nature of these conversations. In particular, further research is needed to understand ways clinicians acknowledge uncertainty and explore options with patients and their families. Additional research is also needed to understand how clinicians manage conversations about difficult matters when healthcare systems are placed under considerable strain, such as during the COVID-19 pandemic. Thro...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.04.27.20078048v1 on medRxiv