Comforting styles of serious illness conversations: a Swiss wide factorial survey study.

Background
Serious illness conversations can cause discomfort in patients, potentially impeding their understanding and decision-making. Identifying ways in which physicians can reduce this discomfort may improve care. This study investigates which physician communication styles and characteristics individuals perceive as comforting in physician-patient serious illness conversations.Methods
We conducted a nationwide online factorial survey in German, French, and Italian with 1572 Swiss participants from the public (51.4% women) aged 16 to 94. Each participant assessed 5 out of 1000 different vignettes describing a physician informing a cancer patient about their terminal prognosis. We systematically manipulated 11 attributes: physician's years of experience, physician sex, patient sex, patient age, prior relationship to physician, clarity of information, self-disclosure, physician taking time, recommendation, expression of sadness, and continuity of care. Participants evaluated their comfort level with the physician described in the vignettes. Multilevel models with random effects were used to analyze the impact of the dimensions on comfort.Results
Clarity of information (β = 2.13, p < 0.01), taking enough time (β = 2.00, p < 0.01), and continuity of care (β = 1.27, p < 0.01) were the strongest predictors of comfort. A prior physician-patient relationship significantly increased comfort, with a longer relationship being more comforting (p < 0.01). Physician self-disclosure (β = 0.40, p < 0.01) and expression of sadness (β = 0.46, p < 0.01; β = 0.58, p < 0.01) also increased comfort. Recommendations based on experience did not influence comfort but failing to provide reasons for recommendations decreased comfort (β = - 0.24, p < 0.01). Recommendations based on patient preference increased comfort (β = 0.30, p < 0.01). A limitation of this study is that the vignettes describe only fictitious situations and can thus be seen as oversimplifications.Conclusions
Taking time, providing clear information, and ensuring continuity of care are pivotal in enhancing comfort. Also relevant are the expression of sadness, physician self-disclosure, and a prior relationship with the patient.