"They must have seen it, you know." Body talk, extension talk, and action talk: A qualitative study on how palliative care patients and their significant others express experiencing these nonverbal cues.

Communication about life-threatening disease and palliative care is essential but often experienced as difficult by those concerned and has mainly been studied in terms of its verbal components. Despite the fundamentality of nonverbal communication, its dimensions in care, especially in the communication by patients and their significant others, has not been as extensively examined. Drawing on a secondary qualitative content analysis of data from 23 interviews-15 with patients in specialized palliative home care in Sweden and 8 with their significant others-this study aims at understanding and characterizing how patients verbally express experiences of conveying nonverbal cues about life-threatening disease and its consequences and how their significant others express perceiving these cues. Patients expressed experiences of nonverbal communication in the form of cues conveying meaning about their disease and its consequences, often beyond their control. Whether and how the patients reinforced these cues verbally, depended on individual needs, care for others, and evaluations of relationships. Significant others acknowledged the presence of nonverbal cues and tried to interpret their meaning. Both patients and significant others emphasized the importance of nonverbal cues and actively related to how cues in the form of bodily appearance, aids, objects and acts, serve communicative functions about disease and its consequences. These dimensions of nonverbal communication are characterized as: body talk, extension talk and action talk. This study contributes to an international knowledge base on the complexities of nonverbal communicative aspects in these dimensions and how it affects patients and significant others. Professionals should be aware that dimensions of care, such as prescribed aids, from the patients' perspective can be perceived as nonverbal cues that might "speak of" disease progression.

Sharing Bad News: Communication Between Patients and Their Loved Ones in a Palliative Care Context.

Background: Although communication is strongly emphasized in palliative care, not much research has focused on communication between patients and their loved ones. The purpose was to increase understanding of communication around severe illness between patients with a life-threatening disease, receiving palliative care, and their loved ones. Secondary intention was to identify strategies making easier for patients to talk about their condition with loved ones. The article is based on in-depth interviews with 15 patients and 8 loved ones. Interviews were analysed using qualitative content analysis. Communication about patient's illness was often described as balancing between wanting to inform or know and wanting to protect. Both patients and loved ones deliberately talk in a way that reflects their relationship. They act, negotiate and communicate aiming at not wanting to create situations that are perceived as uncomfortable, either for themselves or for others. Patients also take everyday practicalities into account. In these interactions, some people become the patients' inner circle - people with whom information is shared and co-owned. Other people find themselves outside the circle and patients may use them as test-subjects - speaking to them about things they might not dare reveal to their inner circle. These considerations are reflected in the themes: What is communicated, How communication is performed, and When it takes place. Our findings show that acting on the ideals of an "open and honest" form of communication is not always to be recommended. Professionals must instead strive to understand and respect the intentions of those involved.