Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence

Abstract

Background: Effective communication between healthcare professionals and relatives of patients approaching the end-of-life is vital to ensure patients have a ‘good death’. To improve communication, it is important to first identify how this is currently being accomplished. Aim: To review qualitative evidence concerning characteristics of communication about prognosis and end-of-life care between healthcare professionals and relatives of patients approaching the end-of-life. Design: Qualitative systematic review (PROSPERO registration CRD42017065560) using thematic synthesis. Peer-reviewed, English language articles exploring the content of conversations and how participants communicated were included. No date restrictions were applied. Quality of included studies was appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data sources: An electronic database search of CINAHL, MEDLINE, PsycINFO and EMBASE was performed. Results: Thirty-one papers were included. Seven themes were identified: highlighting deterioration; involvement in decision-making, post-decision interactional work, tailoring, honesty and clarity, specific techniques for information delivery and roles of different healthcare professionals. Varied levels of family involvement in decision-making were reported. Healthcare professionals used strategies to aid understanding and collaborative decision-making, such as highlighting the patient’s deterioration, referring to patient wishes and tailoring information delivery. Doctors were regarded as responsible for discussing prognosis and decision-making, and nurses for providing individualized care. Conclusion: Findings suggest training could provide healthcare professionals with these strategies to improve communication. Interventions such as question prompt lists could help relatives overcome barriers to involvement in decision-making. Further research is needed to understand communication with relatives in different settings and with different healthcare professionals.

Evaluation of an End-of-Life Essentials Online Education Module on Chronic Complex Illness End-of-Life Care

“…This supports our findings that learners consider acknowledging uncertainty and providing information, checking what the patient understands, and asking what they want to know, as key to prognostic communication. Anderson et al (2019) found that 'highlighting deterioration' was an important element, which involves detailing past and current health problems to emphasise end of life was approaching [24]. The promise of ongoing, continuing care was underlined as essential [24], which is consistent with our findings.…”

“…Individualised or patient-centred care has been identified as an essential component of a safe and high-quality health system in Australia [23]. Patient-centred care, as highlighted in our study, includes the basic tenets of patients and/or family involvement in decision-making [24], of open communication between patients, families, and HCP [25], of sharing power and responsibility, and of accepting patients' life choices [22]. Patients' values, priorities, and goals are considered central to this care planning process, although patients do need to have an understanding of their illness to be able to participate fully in any discussions [26].…”

“…Effective communication requires open and honest conversations that contribute to respectful and compassionate care and has been described as important from the patients' perspective [33,34]. The concept of honesty [24] was reported by learners in the current study as important, as was empathy [35], listening [12], support, reassurance, and kindness, with such caring behaviour a vehicle to instil hope [36]. Hope has been described as a "powerful and vital coping mechanism for a person who is nearing the end of their life" [37] (pp.…”

Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports

“…4,[7][8][9][10] It requires the establishment of a dynamic caring relationship with the patient and family to reduce suffering, and also among nurses themselves and the multi-professional healthcare team. [11][12][13][14][15][16][17][18][19][20][21] Although nursing and palliative care share common roots, goals, and values, to advance palliative care nursing practice, it is essential to discern the unique contribution of nursing to the field of palliative care. The goal of palliative care is to prevent and relieve suffering, and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies.…”

Disclosure and plan of care at end of life: Perspectives of people with intellectual disabilities and families in Ireland

“…As they are dying of the same life‐limiting illnesses as experienced by the general population, people with intellectual disabilities also require the same end‐of‐life care that the rest of the population are being provided with (Coppus, 2013; Tuffrey‐Wijne et al., 2016). Furthermore, it must be pointed out that during such an uncertain time, effective communication is essential between patients, family members and service providers in order to improve the quality of care provided at the end of life (Anderson, Bloch, Amstrong, Stone, & Low, 2019; Brinkman‐Stoppelenburg, Rietjens, & van der Heide, 2014). Also, such conversation helps people with intellectual disabilities understand their clinical situation, decide what kind of care they require, and how they wish to plan towards the end of their life (Ryan, Guerin, Dodd, & McEvoy, 2011; Wagemans et al., 2015).…”