Doctors urged to get better at discussing death with patients

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Doctors need to get better at talking to patients about dying, a report has suggested.

The Royal College of Physicians (RCP) said confidence is one of the main barriers, with many – from medical students to consultants – feeling uncomfortable about initiating such conversations.

Some doctors also avoid the topic as they feel death could be perceived as failure as modern medicine is expected to cure all ailments, the report found.

The RCP said that as nearly half of all deaths in the UK occur in hospital, and many patients admitted to hospital are within the last year of life, it is vital doctors and other healthcare professionals have the knowledge and skills to undertake sensitive conversations at the appropriate time.

It found evidence from patients and carers that many people do want to talk about death, and planning for it helps patients feel more empowered about their care and decision-making.

The report, which is based on conversations with doctors at all levels, along with patients, carers and medical organisations, highlights how medical students and junior doctors often have little practice in talking about the subject with real patients.

Another issue is confusion over whether hospital doctors or the patient’s GP should be having the conversation, along with reluctance to begin conversations if the doctor is 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 were also important factors raised in the report.

But it said evidence shows patients who have had these conversations and have end-of-life care plans put in place have a better experience than those who only have them in the final days or hours of life, when they can seem unexpected to patients and carers.

The report makes a series of recommendations for physicians and the wider healthcare system to improve the situation, including asking the patient if they would like to have the conversation and how much information they want.

All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness should also initiate such discussions, including advance care planning.

Conversations about the future can and should be initiated at any point, it adds.

The General Medical Council (GMC) defines patients as approaching the end of their life when they are likely to die within the next 12 months.

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.”

RCP immediate past-president Professor Dame Jane Dacre said: “Patients value and benefit from clear conversations about the end of life.

“These conversations are difficult, but we need to get better at having difficult conversations.”

Julia Verne, end of life care lead at Public Health England, said: “Doctors and healthcare professionals, like everyone, find it difficult discussing death, but giving patients the opportunity to plan and express their end of life care choices can bring peace of mind to them and their loved ones.

“That’s why it’s so important to have frank conversations with each other.”

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