How do Physicians Talk and what do They Say in the Difficult Conversationswith Patients and their Loved Ones in Palliative Care? A Qualitative Study to Investigate Strategies to Help Improve Difficult Conversations

Objective: Although having difficult conversations is part of their role, many professionals feel that they are often ill-equipped to deal with them. Professionals need training in how best to meet difficult questions so that the conversation can flow effectively. This study is a continuation of an earlier study on how healthcare professionals described strategies to facilitate difficult conversations. Methods: A qualitative method with in-depth interviews was chosen to acquire a deeper understanding of the participants' strategies in having these conversations. In order to strengthen the knowledge of and strategies for conducting their difficult conversations in particular, we examined the interviews with the physicians who participated in the study. Results: The study describes a conversation pattern to help in dealing with difficult conversations. This conversation pattern can help physicians to have conversations that flow effectively and that move in a straightforward way. The different strategic areas described in this study were: Introduction; Finding out what the patient and loved ones already know; Discuss the actual problem; Find out how the patient feels and what is most urgent for the patient to deal with; Planning for the future; and Summary. There are important factors that need to be considered in having these conversations which, in addition to the medical knowledge, include the strategies adopted by patients and families, hope, and how the family constellation might influence the conversation. Conclusion: This framework for difficult conversations can be helpful for physicians to improve conversations with the patient and her/his family in their life situation where a fatal disease has influenced their life within many dimensions. Developing their conversational skills and strategies in combination with a carefully planned structure appeared to facilitate difficult conversations with patients, families and loved ones.