Communicating With Dying Patients Within the Spectrum of Medical Care From Terminal Diagnosis to Death

TLDR

Previous attempts to improve physician–patient communication at the end of life have largely failed, with existing guidelines rooted in expert opinion, and the literature now stresses that end‑of‑life communication must be viewed as a continuum from terminal diagnosis to death. The study aimed to identify which aspects of physician–patient communication are most important during end‑of‑life care. This was achieved through 20 focus groups involving 137 patients, families, hospice and acute‑care professionals, and end‑of‑life specialists, whose discussions were analyzed to delineate domains of physician skill. The analysis revealed that communication with patients is the most critical domain, highlighting six core areas—honest and straightforward dialogue, willingness to discuss dying, sensitive bad‑news delivery, active listening, encouraging patient questions, and sensitivity to readiness—along with subthemes that offer practical guidelines for physicians and educators, and underscoring the need to balance honesty with hope.

Abstract

Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care.Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed.The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope.Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.