ABSTRACT
This chapter provides an overview of different types of difficult conversations that occur between healthcare providers and patients, including discussions marked by sensitive disclosures, challenging health contexts, high-stakes decisions, and charged topics. A defining feature of difficult interactions is that they are characterized to some degree by dilemmas resulting from conflicting conversational goals (e.g., tell the truth while preserving hope, honor patient autonomy while facilitating the best possible health outcome). Overall, research on difficult conversations tends to focus on four main types of research questions or hypotheses: identifying barriers to difficult conversations, describing the content of difficult discussions, explicating the meaning and function of various features of difficult conversations, and predicting outcomes based on whether difficult conversations happened or on the quality of the conversation. Findings within each of these areas have different implications for strategies for engaging in difficult conversations, but collectively, the research suggests that communication that attends to multiple (and potentially conflicting) goals is more successful than communication that ignores relevant goals.
