Related Experiment Video
Updated: Oct 12, 2025
Involving Individuals with Developmental Language Disorder and Their Parents/Carers in Research Priority Setting
Published on: June 6, 2020
Epidemiology of Connectional Silence in specialist serious illness conversations
Cailin J Gramling1, Brigitte N Durieux1, Laurence A Clarfeld2
1University of Vermont, Burlington, VT, USA.
Context:
Human connection can reduce suffering and facilitate meaningful decision-making amid the often terrifying experience of hospitalization for advanced cancer. Some conversational pauses indicate human connection, but we know little about their prevalence, distribution or association with outcomes.
Purpose:
To describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.
Methods:
We audio-recorded 226 inpatient palliative care consultations at two academic centers. We identified pauses lasting 2+ seconds and distinguished Connectional Silences from other pauses, sub-categorized as either Invitational (ICS) or Emotional (ECS). We identified treatment decisional status pre-consultation from medical records and post-consultation via clinicians. Patients self-reported quality-of-life before and one day after consultation.
Results:
Among all 6769 two-second silences, we observed 328 (4.8%) ECS and 240 (3.5%) ICS. ECS prevalence was associated with decisions favoring fewer disease-focused treatments (ORadj: 2.12; 95% CI: 1.12, 4.06). Earlier conversational ECS was associated with improved quality-of-life (p = 0.01). ICS prevalence was associated with clinicians' prognosis expectations.
Conclusions:
Connectional Silences during specialist serious illness conversations are associated with decision-making and improved patient quality-of-life. Further work is necessary to evaluate potential causal relationships.
Practice Implications:
Pauses offer important opportunities to advance the science of human connection in serious illness decision-making.
Related Concept Videos
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:15Techniques of therapeutic communication I: Active Listening, Sharing Observations, Validation, and Using Touch
Therapeutic communication is not the same as social interaction. Social interaction has no goal or purpose and consists of casual information sharing, whereas therapeutic communication has a plan or purpose for the conversation. Therapeutic...
01:18Factors Affecting Illness
For instance, risk factors are connected to illness,...
01:30Therapeutic Communication
Verbal communication depends on language or a prescribed way of using words so that people can share information effectively. The critical aspects of verbal...
01:23Techniques of Therapeutic Communication II: Focusing, Paraphrasing, and Summarizing
This therapeutic technique can also be used when a patient brings up pertinent information during a health-related conversation. The...
01:25Role of Communication in the Nursing Process I: Assessment and Diagnosis
The nursing process considers the patient's emotional and physical well-being. The process can be repeated or stopped at any point if judged essential. Assessment is the first step in the nursing...