New report reveals why doctors struggle to talk to patients about dying

Categories: Featured and Research.

A new report from the Royal College of Physicians (RCP) has revealed the reasons why doctors and other healthcare professionals find it hard to talk to patients about dying.

The report, titled “Talking about dying: How to begin honest conversations about what lies ahead” is based on conversations with doctors at all levels, patients, carers and medical organisations. It has found that the barriers include:

  • Culture – some physicians felt that death could be perceived as a failure and that modern medicine is expected to cure all ailments – however, the evidence from patients and carers is that many people do want to talk about death and planning helps patients feel more empowered about care and decision-making
  • Confidence – from medical students to consultants, there were many doctors who felt uncomfortable initiating conversations about the future with patients; medical students and junior doctors had little practice with real patients; training doesn’t prioritise the ‘soft’ skills needed; and diagnostic uncertainty was often an issue
  • Practicalities – confusion over whether hospital doctors or the patient’s GP should be having the conversation; reluctance to begin conversations when the doctor was not going to be responsible for the patient’s care going forward; workforce pressures; lack of privacy; lack of prioritised

One of the major issues identified in the report is that healthcare professionals need to begin conversations about planning for end of life care nearer the time that patients are given a terminal diagnosis.  The report found that there are multiple opportunities in a patient’s healthcare journey to start honest conversations about future goals and treatments – whether at outpatient appointments, hospital admissions, in social care settings or in the community – as these early conversations allow patients choice and control over the remainder of their lives.

The evidence shows that patients who have had these conversations and have end-of-life care plans put in place have a better experience than those for whom the conversations come in the final days or hours of life when they can seem unexpected to both the patients and their carers.

The report makes a series of recommendations for physicians and the wide healthcare system to improve the situation, including:

  • Ask the patient if they would like to have the conversation and how much information they would want
  • All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness should initiate shared decision making, including advance care planning in line with patient preferences
  • Conversations about the future can and should be initiated at any point, the conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting
  • Be aware of the language they use with patients and those they have identified as being important to them; and try to involve all the relevant people in agreement with the patient

RCP president Professor Andrew Goddard said:

“This report is a big step forward in helping patients, relatives and doctors to talk honestly about death and dying. We must minimise the barriers in our systems and culture that prevent this from happening. This is not just about palliative care in the final days, but about having a series of conversations much earlier after a terminal diagnosis.”

Toby Scott, a spokesman for the Dying Matters coalition led by Hospice UK, said:

“It is vital that our society is more open in talking about dying – something Hospice UK actively encourages through its Dying Matters campaigns – so we welcome this report’s efforts to encourage doctors and other healthcare professionals to have honest conversations with people approaching the end of life early on in their diagnosis.

“Good communication underpins good care and makes a big difference to people nearing the end of life, enabling them to make plans for the support they want earlier on and to have a better care experience.

“As this report acknowledges, nearly half of all deaths in the UK take place in hospital. Hospice UK is working with partner organisations to improve palliative care in hospitals and other clinical settings, with a key focus on promoting timely, compassionate communication between healthcare professionals and patients and their families. “

To read the full report visit Talking about dying: How to begin honest conversations about what lies ahead