Time estimates in prognostic discussions: A conversation analytic study of hospice multidisciplinary team meetings

Abstract

Background: Recommendations state that multidisciplinary team expertise should be utilised for more accurate survival predictions. How the multidisciplinary team discusses prognoses during meetings and how they reference time, is yet to be explored. Aim: To explore how temporality is conveyed in relation to patients’ prognoses during hospice multidisciplinary team meetings. Design: Video-recordings of 24 hospice multidisciplinary team meetings were transcribed and analysed using Conversation Analysis. Setting/participants: A total of 65 staff participating in multidisciplinary team meetings in a UK hospice from May to December 2021. Results: Team members conveyed temporality in three different ways. (i) Staff stated that a patient was dying as part of the patient’s current health status. These formulations did not include a time reference per se but described the patient’s current situation (as dying) instead. (ii) Staff used specific time period references where another specific reference had been provided previously that somehow constrained the timeframe. In these cases, the prognosis would conflict with other proposed care plans. (iii) Staff members used unspecific time period references where the reference appeared vague and there was greater uncertainty about when the patient was expected to die. Conclusions: Unspecific time period references are sufficient for achieving meaningful prognostic talk in multidisciplinary teams. In-depth discussion and accurate prediction of patient prognoses are not deemed a priority nor a necessity of these meetings. Providing precise predictions may be too difficult due to uncertainty and accountability. The lack of staff pursuing more specific time references implies shared knowledge between staff and a context-specific use of prognostic estimates.