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

Open Access
Publisher Website
Google Scholar
Abstract
COMMUNICATION between physicians and dying patients about end-of-life care occurs infrequently1,2; when it occurs, studies suggest that there are important shortcomings in the quality of this communication.3-5 Efforts to improve communication concerning end-of-life issues have been unsuccessful. For example, the SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) study found that poor communication persisted even after an intervention designed to improve communication.1 Although attention to communication at the end of life has increased in recent years, most efforts have focused on specific topics, such as communicating about advance directives and delivering bad news.6-12 For many patients, however, making decisions about medical care in the context of a terminal or life-threatening illness is a prolonged process, and receiving bad news and discussing advance directives are only small parts.13 Few studies have examined the entire spectrum of communication between physicians and dying patients from diagnosis to death or the perspectives of dying patients and family members. Given the lack of empiric data, guidelines for improving patient-physician communication about end-of-life care have been based primarily on expert opinion.12,14