Family conversations about end-of-life health decisions

Communicating about end-of-life decisions can be one of the most challenging and consequential experiences individuals and their families can face. A great deal of end-of-life research is predicated on the reasoning that family communication is critical to the delivery of effective advance care, but there is not a lot of clear evidence that simply talking with family members about end-of-life issues improves the end-of-life experience. Previous work on end-of-life communication has largely assumed that more communication is better communication. The present investigation sought to challenge this assumption by demonstrating that the quality of family communication about end-of-life decisions matters. In this study, a multiple goals theoretical perspective was used to explain how different ways of attending to interaction goals in end-of-life decision making can yield more or less favorable outcomes. Members of 121 older parent-adult child dyads (N = 242) completed a conversational task in which they were asked to discuss end-of-life health decisions. The elicited conversations were rated for several aspects of communication quality, including attention to identity goals (i.e., positive face and negative face), attention to relational goals, and attention to task goals (i.e., low avoidance and high elaboration). Participants also completed a questionnaire in which they reported their perceptions of interaction goals and assessments of the conversation. Results demonstrated that outside ratings of a person’s communication sophistication were associated with that person’s report of as well as the partner’s report of conversation outcomes, including emotional response, decision-making efficacy, conversational satisfaction, and relational distancing. The rated quality of an individual’s communication was also associated with the individual’s perceptions of their own and their partner’s interaction goals, as well as the partner’s perceptions of interaction goals. Perceived interaction goals (i.e., positive face goals, negative face goals, relational goals, avoidance goals, support goals, and influence goals) were also related to the reported outcomes of the conversation. These findings indicate that enacted goal attention and perceived goal attention consistently predict favorable outcomes in family conversations about end-of-life health decisions. Theoretically, the results reinforce the utility of a multiple goals perspective as a theory of message interpretation, suggesting a new direction for multiple goals research, which has tended to focus on message production. Practically, the findings imply that end-of-life conversations in families are most effective when family members are able to address the primary task of engaging in end-of-life talk while also adequately attending to the relevant identity and relational implications of such conversations