Doctors’ Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study

Abstract

(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care—conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients’ wishes: improvements to the healthcare system—the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.

End-of-life communication strategies for healthcare professionals: A scoping review

“…The literature emphasises developing an advanced and comprehensive preparation strategy before initiating endof-life communication with terminally ill patients and their families. [15][16][17]24,26,27,[36][37][38][48][49][50][51][52][53][54][55][56][57] Some documents describe this strategy as 'setting the stage'. 16,17,58 This strategy may include the following.…”

“…(a) Summarising what has been discussed and providing a contract for the next contact; 15,17,24,36,55,57,61,69,72,74 (b) checking in with the patient and confirming what has been said; 15,24,26,36,72 (c) emphasising care continuity and team availability, 14,30,77 making partnership statements and giving reassurance about non-abandonment; [14][15][16]24,26,30,36,77,79 and (d) documenting discussions 49,57 and sharing information within the patient's healthcare team. 56,63…”