End-of-life communication: let’s talk about death

Abstract

Every year more than half a million people die in the United Kingdom, and most of these deaths occur in hospitals.1 While some deaths occur suddenly, the majority of deaths are predictable, occurring after a period of chronic illness. All doctors will at some stage be required to care for patients who are dying and communication is the key to doing this well. Sadly, all too often this is not achieved. Indeed, more than half of NHS complaints are associated with care of the dying, many of them focused on information and communication. Poor communication at the end of life can cause deep distress, both for the patient and their loved ones, and may adversely impact on post-bereavement outcomes. This was highlighted recently by the independent review into the Liverpool Care Pathway (LCP), an integrated care pathway designed to be used in the last days of life, and the subject of intensive media criticism following reports of poor end-of-life care. The independent review identified inadequate communication as responsible for much of the controversy and unhappiness surrounding care of the dying. 3On the other hand, good communication allows patients and their families to make informed decisions about healthcare, to prepare for the future, and to express and meet their preferences for end-of-life care.

A computer-assisted study of the use of Violence metaphors for cancer and end of life by patients, family carers and health professionals

“…Sleeman (2013) claims that many healthcare professionals are reluctant to talk about death with patients (which is reflected particularly in our Example (52) above). She argues that this is because there exists a problematic view that patient death represents failure on the part of the professional, a view which needs to be adjusted if communication about death and dying is to be improved.…”

Recognising and managing dying patients in the acute hospital setting: can we do better?

“…Communication about end‐of‐life care is an essential element of high‐quality care, allowing patients to make informed decisions and to express their values and how these relate to their healthcare choices . Barriers to end‐of‐life communication include the uncertainty about a patient’s prognosis and doctors’ perception that it may jeopardise their relationship with patients or increase patient distress . Hence, it is important that clinicians are equipped with adequate knowledge, skills and attitudes to communicate effectively with patients who are dying …”

Communication Matters: Exploring the Intersection of Family and Practitioner End of Life Communication

“…The pervasiveness of avoiding talk about death and dying or using indirect or euphemistic language in U.S. American culture indicates a societal fear regarding end of life. In fact, death and the associated grieving process are often seen as a taboo topic and equated with a “disease” and something that one needs to quickly “get over” [6]. However, Western society’s avoidance or fear of talking openly about death does more harm than good for individuals actively dying and for the bereaved.…”