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Doctors must talk ‘honestly’ to patients about dying

Report gives advice on how to broach topic

Jo Carlowe

Friday, 19 October 2018

Doctors need to talk ‘honestly’ to patients about dying, according to a new report.

Talking about dying: How to begin honest conversations about what lies ahead, published today by the Royal College of Physicians (RCP), explores the reasons that doctors, and other healthcare professionals find it hard to talk to patients about dying.

Based on conversations with doctors at all levels, patients and carers, and medical organisations, the report reveals the barriers that stand in the way, offers solutions and resources to help, including a ‘myth-busting section’ debunking common but erroneous beliefs.

The barriers to talking about dying identified by doctors include:

  • Culture: Some physicians felt that death could be perceived as a failure and that modern medicine is expected to cure all ailments.
  • Confidence: From medical students to consultants, there were many doctors who felt uncomfortable initiating conversations about the future with patients; medical students and junior doctors had little practice with real patients; training doesn’t prioritise the ‘soft’ skills needed; and diagnostic uncertainty was often an issue.
  • Practicalities: confusion over whether hospital doctors or the patient’s GP should be having the conversation; reluctance to begin conversations when the doctor was not going to be responsible for the patient’s care going forward; workforce pressures; lack of privacy; lack of prioritised clinic or ward time to have the conversations; and the challenges of being sensitive to different cultural and religious beliefs.
One of the major issues identified in the report is that healthcare professionals need to begin conversations about planning for end-of-life care nearer the time that patients are given a terminal diagnosis. The report says that there are multiple opportunities in a patient’s healthcare journey to start honest conversations about future goals and treatments – whether at outpatient appointments, hospital admissions, in social care settings or in the community – as these early conversations allow patients choice and control over the remainder of their lives.

The evidence shows that patients who have had these conversations and have end-of-life care plans put in place have a better experience than those for whom the conversations come in the final days or hours of life when they can seem unexpected to patients and carers.

Commenting 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 today’s report, Dr John Chisholm, British Medical Association medical ethics committee chair, 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.

“This report reflects the BMA’s own research, which found how difficult many doctors find approaching the subject with their patients, and called for better support and training for clinicians in how to initiate these conversations. We therefore welcome the RCP’s report, which explores the reasons why doctors may not be talking to patients about dying and makes a number of useful recommendations.”

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