Objective To investigate views, determinants and barriers to end‐of‐life discussions for doctors, nurses and members of the public (MoP) and their acceptability of risk prediction tools. Methods Concurrent surveys of 360 doctors and nurses and 497 MoP. Results Sixty per cent of clinicians reported high confidence in initiating end‐of‐life discussions, and 55.8% regularly engaged in them. Barriers to end‐of‐life communication reported by clinicians were uncertainty on the likely time to death (44.7%) and family requests to withhold information from patients (44.2%). By contrast, most (92.8%) MoP wanted information about life expectancy; 89.9% wanted involvement in treatment decisions if the likelihood of death was high; and 23.8% already had an advance care directive. Conclusions A dissonance exists between doctor/nurses perception of older peoples’ preference for receiving prognostic information and the public desire for involvement in decision‐making at the end of life. As public attitudes change, strategies for greater involvement of patients in shared end‐of‐life planning are warranted.

Initiating end-of-life discussions with patients is often delayed or avoided altogether by health care practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at end-of-life. We surveyed health care practitioners to elicit their exposure to and confidence in end-of-life discussions and to better understand factors that enable or challenge the initiation of discussions in Australian health care settings. Thematic analysis identified that end-of-life discussions could be emotionally burdensome for health care practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between health care practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role-play and mentoring particularly for younger nurses and doctors were identified. Specific training in end-of-life communications should target undergraduates and new health care practitioners 3

The patient and family perspective on the appropriateness of intensive care unit (ICU) treatments involves preferences, values and social constructs beyond medical criteria. The clinician's perception of inappropriateness is more reliant on clinical judgment. Earlier consultation with families before ICU admission and patient education on the outcomes of life-sustaining therapies may help reconcile these provider–patient disagreements. However, global emergencies like COVID-19 change the usual paradigm of end-of-life care, as it is a new disease with only scarce predictive information about it. Pandemics can also bring about the burdensome predicament of doctors having to make unwanted choices of rationing access to the ICU when demand for otherwise life-saving resources exceeds supply. Evidence-based prognostic checklists may guide treatment triage but the principles of shared decision-making are unchanged. Yet, they need to be altered with respect to COVID-19, defining likely outcomes and likelihood of benefit for the patient, and clarifying their willingness to take on the risks inherent to being in an ICU for 2 weeks for those eligible. For patients who are admitted during the prodrome of COVID-19 disease, or those who deteriorate in the second week, clinicians have some lead time in hospital to have appropriate discussions about ceilings of treatments offered based on severity.Key pointsThe patient and family perspective on inappropriateness of intensive care at the end of life often differs from the clinician's opinion due to the nonmedical frame of mind.To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction is a good start to reconcile differences between physician and health service users’ viewpoints.During pandemics, where health systems may collapse, different admission criteria driven by the need to ration services may be warranted.Educational aimsTo explore the extent to which older patients and their families are involved in decisions about appropriateness of intensive care admission or treatmentsTo understand how patients or their families define inappropriate intensive care admission or treatmentsTo reflect on the implications of decision to admit or not to admit to the intensive care unit in the face of acute resource shortages during a pandemic

Links between religiosity, spirituality and disordered eating have been posited theoretically and empirically, though most studies have accessed predominantly Christian or Jewish samples from private educational institutions, using surveys which contain a heavy JudeoChristian bias. The aim of the current study is to explore the relationship between disordered eating psychopathology (DEP) and spiritual, religious and personal beliefs (SRPBs) in a diverse sample of students with a wide range of cultural, religious and spiritual affiliations. Using a cross-sectional design, female students (n = 687) across two universities in Sydney, Australia completed the Eating Disorder Inventory-3 and the SRPB portion of the World Health Organisation Quality of Life -Spiritual, Religious and Personal Beliefs bref (WHOQOL-SRPB bref) questionnaire. While both existential and religious beliefs were significantly correlated with lower levels of DEP, multivariate analysis found that existential beliefs alone predicted DEP (p < 0.001). These results reveal that spiritual and personal beliefs may have a greater role in predicting lower levels of DEP than religious beliefs in a secular university setting. Furthermore, the findings may have important clinical implications including the exploration of existential and religious mechanisms within current treatment models.