Communication at End of Life
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Communication at End of Life

Key Messages

  • Good communication underpins the quality of palliative care [1] and is associated with better quality of life for older adults receiving palliative care. [2]
  • Older adults would like the opportunity to discuss their end-of-life needs and often value frank conversations with health care professionals. [2-4]
  • Older adults are more likely to wait for health professionals to raise the topic of end-of-life discussion than initiate the discussion [5,6]
  • It is often not clear which health professional should lead end-of-life discussions. [1,3,5] Preferably, this should be someone with whom the person feels comfortable and with whom he or she will have regular contact.  [1,3,5]
  • The timing, content, pace and setting of conversations are important in helping people deal with difficult issues at or near end of life. [3,5]
  • Professional interpreters should be considered to enhance end-of-life care for people from different cultural backgrounds [7]
  • Older adults may want practical information on how their condition will affect activities of daily living and what to expect as health deteriorates, but may not want prognostic information. [5,6]

Background

Recent years have seen significant improvement in the provision of palliative and end-of-life care, with communication between health professionals, the person and their family at the core of a positive end-of-life experience. [2] There is concern that despite improvements in care, discussion of end-of-life planning is not always delivered in a timely manner, may be ineffective or of poor quality. [1,4,5]

Evidence Summary

A significant number of older adults with non-malignant but progressive and life-limiting conditions receive palliative and end-of-life care. [8] The importance of good communication in the end-of-life phase has long been recognised by health care providers and has been shown to improve the person’s and their family’s understanding, enhance therapeutic relationships, facilitate access to appropriate services, increase compliance with treatment, and improve overall quality of life for the older adult. [1,2]

It appears that end-of-life conversations occur readily with older adults who have a diagnosed malignancy where the prognosis is more easily measurable. [5] This is not always the case for older people with non-malignant illness with unpredictable end-of-life trajectories. Research suggests that most but not all older adults would like the opportunity to discuss their end-of-life needs, and that these discussions should happen even in the absence of illness and predicted trajectory to death. [3,4] This is particularly relevant as there are an increasing number of frail elderly with significant comorbidity and challenging health care needs. [1]

The literature states that health professionals should initiate end-of-life discussions without defining which health professional should assume this responsibility or at what point in time. [5] Nominating a key health professional with whom the person feels comfortable and with whom he or she will have regular contact could assist in reducing anxiety and confusion in the older adult. [1,3] Offering multiple occasions to discuss end-of-life care may be important as studies show that health professionals often perceive themselves to have provided prognostic information more often than people reported receiving it. [3,5] Older adults may want practical information on how their condition will affect activities of daily living and what to expect as health deteriorates but may not want prognostic information. [5,6]

The desire and need for information may be significantly different for the person receiving palliative care compared to the family and carer(s). [2] These changes present challenges to the team providing palliative care. A certain percentage of older people feel that end-of-life discussions should be a routine component of healthcare, yet the same review showed that older people discuss terminal care with family members more than with their doctor. [4] Other research indicates that advance care conversations presented as a person’s right could encourage people to seek out information to help make informed decisions. [4] This may not be realistic for frail older people. [4]

A person’s understanding of their disease is shown to be helpful in reconciling the subsequent prognosis. It is also important to consider the timing, individual readiness and volume and type of information provided as well as the environment information is delivered in. [2,3,5] The use of professional interpreters should also be considered when providing information to people from different linguistic backgrounds. Research indicates quality of care may be improved and recommends interpreters are provided with support and education around the delivery of information. [7]

Quality Statement

The quality of the included reviews was acceptable [1-3,7,8] with two reviews found to be of high quality  [4,5] and one low quality. [6] Overall, the quality of the evidence was mixed mainly due to lack of methodology or quality reporting in the papers. 
 

Page updated 17 June 2021
 

  • References

  • About PubMed Search

  1. Murray CD, McDonald C, Atkin H. The communication experiences of patients with palliative care needs: A systematic review and meta-synthesis of qualitative findings. Palliat Support Care. 2015 Apr;13(2):369-83.
  2. Walczak A, Butow PN, Bu S, Clayton JM. A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work? Patient Educ Couns. 2016 Jan;99(1):3-16.
  3. Barclay S, Momen N, Case-Upton S, Kuhn I, Smith E. End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Br J Gen Pract. 2011 Jan;61(582):e49-62.
  4. Sharp T, Moran E, Kuhn I, Barclay S. Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis. Br J Gen Pract. 2013 Oct;63(615):e657-68
  5. Stephen N, Skirton H, Woodward V, Prigmore S, Endacott R. End-of-life care discussions with nonmalignant respiratory disease patients: a systematic review. J Palliat Med. 2013 May;16(5):555-65
  6. Garland EL, Bruce A, Stajduhar K. Exposing barriers to end-of-life communication in heart failure: an integrative review. Can J Cardiovasc Nurs. 2013 Winter;23(1):12-8.
  7. Silva MD, Genoff M, Zaballa A, Jewell S, Stabler S, Gany FM, et al. Interpreting at the End of Life: A Systematic Review of the Impact of Interpreters on the Delivery of Palliative Care Services to Cancer Patients With Limited English Proficiency. J Pain Symptom Manage. 2016 Mar;51(3):569-80. doi: 10.1016/j.jpainsymman.2015.10.011. Epub 2015 Nov 5.
  8. de Graaff FM, Mistiaen P, Deville WL, Francke AL. Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review. BMC Palliat Care. 2012 Sep 18;11:17.

Communication at End-of-Life

Definition

Communication: The exchange or transmission of ideas, attitudes, or beliefs between individuals or groups.(Source: MeSH Thesaurus). 

Searches

Final search

Modified final search to be more specific (28/1/17 ML)
((communication[mh] OR ((communicat*[tiab] OR conversation*[tiab] OR Information sharing[tiab] OR shared information[tiab] OR miscommunication[tiab] OR misunderstanding*[tiab] OR discuss*[tiab]  OR talk*[tiab]) NOT medline[sb]))

Old search 

communication[mh] OR communicat*[tiab] OR conversation*[tiab] OR Information sharing[tiab] OR shared information[tiab] OR miscommunication[tiab] OR misunderstanding*[tiab] OR discuss*[tiab]  OR talk*[tiab]