Uncertainty, responsibility, and reassurance in paediatric palliative care: A conversation analytic study of telephone conversations between parents and clinicians

Abstract

Background: Families play a vital role in the day-to-day medical care of children with life-limiting conditions. Navigating their child’s symptoms, treatments, and the possibility of sudden deteriorations, presents myriad challenges and can be distressing for the family. Paediatric palliative care can provide crucial support for families who are typically responsible for many aspects of their child’s care. Aim: To understand how paediatric palliative care clinicians use reassurance to support families through the uncertainties associated with caring for their children. Methods: One hundred routine telephone conversations between parents and clinicians of a paediatric palliative care service were recorded and analysed using Conversation Analytic methods. Findings: When parents report uncertainty about a specific care task, imply a causal link between this care task and an adverse outcome for their child, and a moral responsibility for the outcome, clinicians respond with reassurance. Clinicians produce reassurance through refuting parents’ accounts and providing an explanation to reframe the potential adverse outcome as independent of parent actions. Parents often agree with the clinicians’ reframings and demonstrate being reassured. Discussion: Specialist paediatric palliative care clinicians routinely foreground support for family members through reassurance. Conclusions: This study demonstrates how family-centred care can be accomplished in clinical practice.