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What is symptom meaning? A framework analysis of communication in palliative care consultations
Celina F Estacio1, Phyllis N Butow2, Melanie R Lovell3
1Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), Lifehouse Level 6-North (C39Z), University of Sydney, NSW 2006, Australia; HammondCare Palliative and Supportive Care Service, Greenwich Hospital, Greenwich, NSW 2065, Australia; Kolling Institute, Northern Clinical School, Faculty of Medicine, University of Sydney, NSW 2006, Australia.
Objective:
There is a limited understanding of symptom meaning and its significance to clinical practice within symptom experience literature. This study aims to qualitatively explore the ways in which symptom meanings are discussed by patients and responded to by palliative care physicians during consultations.
Methods:
Framework analysis was conducted with 40 palliative care consultation transcripts.
Results:
55% of consultations discussed symptom meaning. Six themes regarding patients' symptom meanings emerged while four themes conveyed physicians' responses to these utterances. Key symptom meanings included symptoms representing diminished function and uncertainty about symptom cause or future. Physicians usually gave scientific medical responses concerning symptom cause and treatment, versus reassurance or empathy.
Conclusion:
This study has provided greater insight into the different symptom meanings that exist for palliative care patients. Physicians' responses highlight their reliance on medical information when patients are distressed. Future studies should explore the impact of different responses on patient outcomes, and health practitioners' views about optimal responses.
Practice Implications:
Physicians could explore symptom meanings with their patients, looking out for those identified here. Apart from information-giving and treatment, active listening to these concerns as they present in consultations may help improve the therapeutic relationship and better guide optimal care.
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