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Palliative Care Communication: Linking Patients' Prognoses, Values, and Goals of Care


  • Greenwall/Kornfeld Foundation Research Grant (Gramling, Norton, Alexander), National Palliative Care Research Center Career Development Award (Gramling), and a Ruth L. Kirchstein National Research Service Award, Fellowship 1F31 NR012084-01 (Metzger). Appreciation to Susan Ladwig and to the patients, family members, and clinicians who participated in this study.


Prognostic communication is a primary component of goals of care conversations in palliative care (PC) practice. Little is known about these conversations in the natural setting. This study's aim was to describe the processes of prognostic communication in PC goals of care consultations. Using line-by-line qualitative analysis, we examined prognostic conversation in 66 audio-taped PC consultations. We identified five processes by which clinicians link prognoses, values, and goals of care: (1) signposting the crossroads; (2) closing off a goal; (3) clarifying current path; (4) linking paths and patients' values; and (5) choosing among paths. The findings add to our understanding of PC consultation by describing how prognoses link with patients' values and choices in goals of care conversations. © 2013 Wiley Periodicals, Inc. Res Nurs Health 36: 582–590, 2013