Advance Care Planning, Communication Challenges, and Competing Timelines at the End of Life

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 19. Patient Experiences

Abstract

What communication challenges do physicians and caregivers encounter in advance care planning and end-of-life decision-making, and how can these challenges be understood in terms of competing timelines and time constraints? Utilizing qualitative focus group data, we draw on scholarly understandings of time as individually embodied, institutionally organized, and socially constructed to examine how healthcare providers and recently bereaved caregivers of older adults narrate difficulties surrounding end-of-life communication. Participant accounts reflect tensions between bodily time (the dying process), institutional and relational time (clinical schedules and priorities, rapport, and familial concordance), and emotional time (individual and cultural trajectories of faith, hope, denial, grief). Caregivers describe conversations that felt delayed, rushed, or avoided altogether, as well as confusion about medical terminology and treatment options at the end of life. While physicians express confidence in their communication practices, they also describe time constraints—tight scheduling, limited rapport-building opportunities, and cultural stigma surrounding death—that structure how and when important conversations take place. Our findings highlight how bodily, institutional, and social timelines compete to shape how communication surrounding death and dying unfolds, emphasizing the structuring power of institutional time constraints and pointing to sociotemporality as a valuable lens for understanding end-of-life communication challenges.

Authors

• Sarah E Koch, Vanderbilt University

• Emily S Schuler, Vanderbilt University

• Nashell Wilson, Vanderbilt University

• Lucie Kalousova, Vanderbilt University

• Deborah Carr, Boston University