Three Principles to Improve Clinician Communication for Advance Care Planning: Overcoming Emotional, Cognitive, and Skill Barriers

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Abstract
Medical care of patients with life limiting illness remains fraught with serious deficiencies, including inadequate advance care planning, delayed hospice referral, and continued delivery of aggressive treatment that is overtly counter to patients' preferences. This paper describes clinicians' emotional, cognitive, and skill barriers to shared decision-making with seriously ill patients and their loved ones. Thematic literature review. Based on a literature review, as well as clinical and educational experience, we articulate three principles to address these barriers and guide future professional communication training for advance care planning. We argue that these barriers must be overcome before deficiencies in end-of-life care can be fully ameliorated.