Getting Better at Talking About Death

Nicky Broyd

October 22, 2018

Doctors and other healthcare professionals are being offered 'mythbusting' tips in a new Royal College of Physicians (RCP) report exploring why many find it so hard to talk about death with their patients.

The report, called Talking about dying: How to begin honest conversations about what lies aheadexplores barriers to conversations about dying as well as including case studies on best practice.

Barriers to Death Conversations

The report found that while many patients would welcome honest conversations about death to help with their own care and decision making, some doctors saw the need for this talk as a failure. This, the authors say, could be due to what physicians perceived as a culture among the public to expect modern medicine to cure all ailments, combined with a culture within the profession itself to see death as a failure.

Medical school training should prioritise 'soft skills' needed for end of life conversations, the report says, finding that doctors at all levels may feel uncomfortable about starting such discussions. It acknowledges that real-life experience with patients was lacking for medical students and junior doctors and found uncertainty over diagnosis could be an issue.

Who should initiate the conversation about death – a doctor in hospital or the patient's GP? The report found confusion over this role, citing time pressures, responsibility for end of life care, privacy on hospital wards, and cultural and religious sensitivities.

Recommendations

The reports key recommendations for health professionals are:

  • Have the end of life care conversation much earlier after a terminal diagnosis is delivered

  • Ask the patient if they want to talk about the end of their life and how much information they want

  • Remember that conversations about the future can and should be initiated at any point and that further opportunities for discussions are possible at admission to hospital, at outpatient appointments, or in social care

  • The conversation does not have to reach a conclusion at one sitting

  • Be mindful of the language used with patients and their loved ones and try to involve all the relevant people in agreement with the patient

The report says having death conversations results in a better experience around death for both the patient and their relatives or carers

'A Big Step Forward'

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."

Responding to the report, BMA Medical Ethics Committee chair, Dr John Chisholm, said: "Open, honest and sensitive conversations about death between doctors, patients and their loved ones are crucial if patients are to receive the best end-of-life care possible, but this does not mean those conversations are easy." 

Royal College of GPs' Joint Honorary Secretary, Dr Victoria Tzortziou Brown, said: "We understand that people might not always feel comfortable talking about end of life care, but patients should feel reassured that GPs are highly-trained to have sensitive conversations with them and their families in order to ensure that their plans and wishes are met.

"Society places huge importance on talking about birth – and rightly so – but this should also extend to talking about death and making sure our patients are given the right support and guidance when they are at their most vulnerable."
 

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