Directly observed patient-physician discussions in palliative and end-of-life care: a systematic review of the literature. Review uri icon



  • Humans

MeSH Major

  • Choice Behavior
  • Communication
  • Hospices
  • Palliative Care
  • Physician-Patient Relations


  • To review studies that used direct observation (i.e., videotaping or audiotaping) methods in palliative/end-of-life care communication research. Descriptive thematic analysis. Multinational studies were conducted in both the outpatient and inpatient setting. Extensive bibliographic searches (January 1, 1998 to July 31, 2009) of English-language literature involving physician-patient (or physician-family) interactions were conducted and augmented by reviews of reference listings. Three investigators independently abstracted key information from each article. Of the 20 retained articles, most enrolled young-old participants (mean age, 60 years) who were white and had a cancer diagnosis. Patient/family participation rates ranged from 68% to 89% demonstrating feasibility of this approach when studying palliative/end-of-life care communication issues. Four common themes were identified: (1) physicians focus on medical/technical and avoid emotional/quality of life issues; (2) sensitive topics are perceived by physicians to take longer to discuss and often do take longer to discuss; (3) physicians dominate discussions; and (4) patient/family satisfaction is associated with supportive physician behaviors. This study demonstrates that direct observation methods can be feasibly used when studying physician-patient/physician-family communication in palliative/end-of-life care, but few investigations have utilized this approach. This article highlights areas that need improvement, including physicians' ability to address patient/family emotional issues and provide what patients and families find most satisfying (participation and support). A particular focus on older patients and patients with end-stage or late-stage chronic (noncancer) illness, the adaptation/application of existing communication measurement tools to capture palliative care communication issues, and development of corresponding outcome measures to assess impact is now needed.

publication date

  • May 2010

has subject area

  • Choice Behavior
  • Communication
  • Hospices
  • Humans
  • Palliative Care
  • Physician-Patient Relations



  • Journal Article
  • Review



  • eng

PubMed Central ID

  • PMC2938894

Digital Object Identifier (DOI)

  • 10.1089/jpm.2009.0388

PubMed ID

  • 20491550

Additional Document Info

start page

  • 595

end page

  • 603


  • 13


  • 5