• Rebecca J Anderson, Patrick C Stone, Joseph T S Low, and Steven Bloch.
• Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK. Electronic address: rebecca.anderson.16@ucl.ac.uk.
• Patient Educ Couns. 2021 May 1; 104 (5): 1075-1085.

ObjectiveTo examine transitions out of prognostic talk in interactions between clinicians and the relatives and friends of imminently dying hospice patients.MethodsConversation analysis of 20 conversations between specialist palliative care clinicians and the families of imminently dying patients in a hospice.ResultsFollowing the provision and acknowledgement of a prognostic estimate, clinicians were able to transition gradually towards making assurances about actions that could be taken to ensure patient comfort. When families raised concerns or questions, this transition sequence was extended. Clinicians addressed these questions or concerns and then pivoted to action-oriented talk, most often relating to patient comfort.ConclusionIn conversations at the end of life, families and clinicians used practices to transition from the uncertainty of prognosis to more certain, controllable topics including comfort care.Practice ImplicationsIn a context in which there is a great deal of uncertainty, transitioning towards talk on comfort care can emphasise action and the continued care of the patient and their family.Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

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