Abstract| Volume 63, ISSUE 6, P1071-1072, June 2022

Connectional Silence and Goal Expression in Serious Illness Conversation (RP308)

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      1. Learners will be able to contrast two examples of connectional silence
      2. Learners will be able to describe two types of goal expressions


      Some pauses in serious illness conversations mark moments of human connection amid the isolating, confusing, and often terrifying experience of hospitalization for advanced cancer. The presence of these “connectional silences” is associated with proximal decision making and quality-of-life outcomes. However, little is known about the intraconversational processes that are associated with the expression of connectional silence.


      To explore the association between connectional silence and patient or family expression of perspectives about treatment goals during palliative care consultations.


      As part of a multisite cohort study, we audio-recorded initial palliative care consultations involving 199 hospitalized people with advanced cancer and 54 specialty palliative care clinicians. Using a tandem machine learning–human coding method, we identified conversational pauses lasting 2+ seconds in the 96 audio hours and distinguished connectional silences from other pauses. Using traditional human coding, we identified patient and family expressions about treatment goals and subcategorized them into those relating to physical and role function, duration of life, symptom control, and place of living. We used standard epidemiology methods to describe the association between the presence of connectional silence and expression of goals.


      Connectional silence and goal expression occurred in 58% (116/199) and 59% (117/199) of consultations, respectively. Goal expression was more common in conversations with at least one connectional silence compared to others (69% vs 45%, p = 0.001). We observed similar associations across gender and racial identities. The association persisted for specific goal expressions about function (p = 0.006), symptom control (p < 0.001), and life prolongation (p = 0.05) but not about place of living (p = 0.77).


      Connectional silence is associated with goal expression in inpatient palliative care serious illness conversations.


      These findings support the need to better understand the role of connectional silence in participatory decision-making communication.