Epidemiology of Connectional Silence in specialist serious illness conversations |
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| Institution: | 1. University of Vermont, Burlington, VT, USA;2. Department of Computer Science, University of Vermont, Burlington, VT, USA;3. Complex Systems & Data Science, University of Vermont, Burlington, VT, USA;4. InSpace Proximity, Burlington, VT, USA;5. Department of Family Medicine, University of Vermont, Burlington, VT, USA;6. Department of Civil Engineering, University of Vermont, Burlington, VT, USA;1. Maastricht University, Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands;2. Maastricht University, Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands;3. RCSI University of Medicine and Health Sciences, Health Professions Education Centre, Dublin, Ireland;1. Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA;2. Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA;3. Department of Biomedical Informatics, Columbia University, New York, NY, USA;4. Weill Cornell Medicine Samuel J Wood Library, New York, NY, USA;5. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA;1. Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany;2. University of Education Freiburg, Department of Public Health and Health Education, Germany;3. Beuth University of Applied Sciences, Berlin, Germany;4. Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany;1. University of Kansas School of Medicine, Department of Population Health, Kansas City, KS USA;2. University of Kansas School of Nursing, Kansas City, KS USA;1. University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia;2. Hunter New England Local Health District, Tamworth, NSW 2340, Australia;3. Rheumatology Practice, Tamworth, NSW 2340, Australia;1. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium;2. Department of Palliative Care, University Hospitals Leuven, Belgium;3. LUCAS KU Leuven Centre for Care Research & Consultancy, Leuven, Belgium;4. Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium;5. Department of Oncology, KU Leuven, Leuven, Belgium |
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| Abstract: | ContextHuman 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.PurposeTo describe the epidemiology of Connectional Silence during serious illness conversations in advanced cancer.MethodsWe 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.ResultsAmong 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.ConclusionsConnectional 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 implicationsPauses offer important opportunities to advance the science of human connection in serious illness decision-making. |
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| Keywords: | Silence Pause Conversation Cancer Communication Palliative care |
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