"If it's the time, it's the time": Existential communication in naturally-occurring palliative care conversations with individuals with advanced cancer, their families, and clinicians.
Elise C Tarbi, Robert Gramling, Christine Bradway and 1 others
PMID 33992483WHAT IT FOUND
In palliative care conversations, patients and families expressed existential concerns through practical talk about time, daily routines, and relationships.
These moments may be openings to ask what matters most, not merely administrative talk.
Key findings
01Existential concerns were rarely stated outright, but were woven into practical talk about symptoms, treatment decisions, and future planning.
02Time was a central existential theme, with patients and families describing lost, wasted, bought, spent, and rich time.
03Maintaining a coherent self and connecting with others were also ways existential experience appeared in these conversations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was English-speaking, predominantly White, and Christian, so the themes may not transfer to other cultural or spiritual groups. The analysis used audio transcripts without nonverbal cues, so tone, pauses, and facial expression were not considered. The conversation was treated as the unit, not the speaker, so differences between patients, families, and clinicians were not examined. It was conducted during one inpatient hospital stay, so it may not reflect conversations in outpatient, home, or hospice settings or how they change over time.
Declared interests
The authors declared no competing interests. The article is tagged as supported by NIH and non-U.S. government funding.
The easy way to misread this
Do not read this as evidence that directly asking about existential concerns improves patient outcomes. The study described how such concerns appeared, mostly woven into practical talk, and did not test a communication intervention.