Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

To examine how end-of-life talk is initiated in CALM therapy sessions with advanced cancer patients.

Conversation analysis was used to systematically examine the sequences where talk about death was raised in the first sessions of ten patients.

Open questions about the patients' experiences, feelings or understanding in the context of talk about their troubles, were found to regularly elicit talk concerning end-of-life. These questions were designed in ways that invite patients to discuss troubling aspects of their cancer journey, without making discussion of this topic an interactional requirement. That is, the interactional work required to not engage in such talk is minimised. This choice is provided through the open question design, the degree to which negative feeling descriptors are specified, and the sequential context of the question.

The analysis shows that therapists provide patients with the opportunity to talk about end-of-life in a way that is supportive of the therapeutic relationship. The readiness of patients to engage in end-of-life talk displays the salience of this topic, as well as the reflective space provided by CALM therapy.

The results provide important insight into the process of CALM therapy, which can be used to guide training.