Family perceptions of prognosis, silence, and the "suddenness" of death

Studies of end-of-life communication and care have emphasized physician-patient conversations, often to the exclusion of family members' discussions and interactions with providers, or with patients themselves. Relatively little is known therefore about families' experiences of end-of-life care in the hospital, or the concrete meanings and practices through which families conceive and define communication. Yet increasingly, family members are asked to serve as surrogates and thereby to participate in the facilitation of decisions for medical procedures and the withdrawal of treatments. It is thus worthwhile to consider their perceptions and involvement in hospitalization at the end of life. This paper offers a descriptive account of families' assessments of communication at life's end in the hospital--focusing in particular on their understandings of and conversations about prognosis and its implications. It reflects on the burdens of responsibility and regret posed to families by the ways communication is both conceived and evaded by different players in the hospital setting.