Background
Methods
Patient and public involvement
Data analysis
Results
Proposing hospice in an implicit way
Extract 1
01 D: I think we need to talk about (0.5) what’s been going on for the last few days. The fact02 that you didn’t respond to the spinal taps (.) I wouldn’t want to put you through any more03 spinal taps. There’s going to be a time (.) when we’re not going to be able to deal with the04 pressure (.) with the [steroids.05 P: [Okay.06 D:We will be able to help with pain and in making you comfortable.07 I’m worried that your disease is progressing quickly.08 We’ve talked about (.) you know (.) hospice before.09 And I think this is the time where we need to discuss a bit more about it.10 P:Well (.)Mary and I have talked many times and my thought again is I’m not afraid to die, but11 I’m afraid of all the suffering that goes beforehand. So we just-we’re trying to find out,12 you know, when that is going to come to pass just so we can-we can say goodbye to each13 other.
Soliciting the patient’s goals on pain management
Extract 2
01D: What should our goals be?02P: My goals (.) I-I don’t-I want to be pain-free. I’ll be honest about that (.) I want to be03 pain-free, I don’t like pain. I-I don’t-I can’t-I can tolerate emotional pain to a certain point,04 but I cannot tolerate physical pain. I want to have some sort of pain-free living standard05 where I can go on you know. And I want people to know that around me that are working06 with me that this is (.) this is it from me. You know, this is where I am going, this where I'm,07 and this is where-where I want to be. I don’t want to (.) people, I don’t want to fool people.08 I know where I’m going. I’m- I’m in a-I’m in a dangerous situation. You know (.) I may not09 wake up tomorrow. I may not wake up tomorrow. And my (0.5) and my husband knows that.10 I know that. Well (.) all of the preparations are done. Everything is ready. And this is the11 place for us to do it. This is where we get the support that we need.
Soliciting the patient’s presenting pain concerns
Extract 3
01 D: Being in bed as you are right now, sitting quite still, do you have any pain at all right now?02 P: No, no.03 D: Oh, no pain right now?04 P: No.05 D: So what you are saying is that when your sit in bed as you are, you are comfortable?06 P: Yes.07 D: If you get up and try to walk, then your legs are painful?08 P: Yeah, painful yeah.
Displaying affiliation with the patient’s pain concerns
Extract 4
01 P: If I can walk without pain, that will be something fine =02 D: =Ye:ah(1.0)03 P: I have had pain there for-for-for 5 months now.04 D: Hmm (.) Hmm. Well (.) that’s what we’re aiming for (.) get rid of the pain (.) and get you05 walking.06 P: Yeah.
Alleviating the patient’s pain concerns
Extract 5
01 D:When you wake up like that, it’s because you are worried or because of pain, or you just.02 wake up?03 P:It-It-It could be pain but no, and I don’t worry. Well (.) of course, when here, you (0.5) you04 don’t know how it’s going to end and there is always a bit of anxiety against the same for.05 everybody, but it was the same at home, I wouldn’t sleep at night (.) it was my nightmare too.06D: What do you mean you don’t know how it’s going to end?07P: Am I going to suffer? How is it going to (.) Am I going to get into a coma? It’s all question.08 that you, we don’t know, but there is always, you know (.) you-you ask yourself.09D: What do you think will happen? What do you imagine might happen?10 P: Well, to me cancer, it means it’s not curable and you suffer a lot.11 D: You suffer a lot like from pain.12 P: Yeah, Yeah (.) Maybe I’m wrong today (.) maybe they’ve got [medication.13 D: [Yeah.14 P: but to me, that’s the way it is.15 D: What if I told you that we do have the means and we do have the medication to control pain.16 in almost all cases, like almost a hundred percent.27 P: Yeah.