General Practitioners' Strategies and Tactics of Communication with the Terminally III

Interviews with 22 randomly selected general practitioners (GPs)investigated their communication with terminally ill patients.In interview analysis a conceptual distinction was drawn betweenobjectives, strategies and tactics. When treating terminal patients,GPs expressed the objectives of keeping the patient comfortable,painfree, happy and maintaining dignity. A strategy is a planand mode of approaching patients existing over an extended timeperiod. Three strategies were described by GPs for use wheninteracting with terminally ill patients. These are characterizedas ‘try to disclose’, ‘let the patient decide’and ‘avoid disclosing’. Tactics refer to behavioursused within a single consultation, as part of a strategy. Sixtactics are described: evasion, denial, uncertainty, hints andprompts, euphemism and reassurance. Different strategies implyquite different forms of consultation. Thus to understand aconsultation we must place it into the context of the series.