• Elizabeth Fine, M Carrington Reid, Rouzi Shengelia, and Ronald D Adelman.
• Department of Geriatrics, Center for Geriatrics, University Hospitals, Case Medical Center, Cleveland, Ohio 44106, USA. Elizabeth.Fine@uhhospitals.org
• J Palliat Med. 2010 May 1;13(5):595-603.

ObjectivesTo review studies that used direct observation (i.e., videotaping or audiotaping) methods in palliative/end-of-life care communication research.DesignDescriptive thematic analysis.SettingMultinational studies were conducted in both the outpatient and inpatient setting.MeasurementsExtensive 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.ResultsOf 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.ConclusionsThis 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.

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