Prioritizing the Values, Wishes, and Needs of Patients with Advanced Cancer: A Secondary Linguistic Analysis.

Abstract

Linguistic research on communication regarding the values, wishes, and needs of patients with advanced cancer in the palliative phase is limited, resulting in an inadequate understanding of clinicians' communication. To explore the verbal expressions used by hospital oncology clinicians regarding the VWN of patients with advanced cancer in the palliative phase and to examine the clinician's speech acts and speech act patterns employed during outpatient consultations. A secondary linguistic analysis was performed. Physicians, nurse practitioners and nurses were previously recruited. Content analysis was performed to explore what clinicians expressed verbally about VWN during semi-structured interviews (N = 7). Functional pragmatic analysis was conducted to identify the clinician's speech acts and speech act patterns employed during outpatient consultations (N = 7). Speech acts encompass words/phrases used to perform functions in communication. Speech act patterns were combinations of speech acts used to achieve communicative goals. Clinicians were interviewed once and/or observed multiple times. Eleven clinicians participated. Three findings reveal clinicians' expressions about VWN: 1) Prioritizing patients' VWN in patient-clinician interactions, 2) Trying to understand perspectives of advanced illness, and 3) Seeking to facilitate dialogue on coping with advanced illness. Four findings describe the clinician's speech acts and patterns: 1) Discussing the treatment goal, 2) Focusing on action, 3) Providing Limited Space to Discuss Patients' VWN and 4) Responding to patient emotions. Clinicians did not adequately address patients' VWN in their communication, thereby limiting opportunities for patients to discuss it. The study's findings contribute to improving communication training materials in palliative care.