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

Abstract

Background: Timely and effective communication about end-of-life issues, including conversations about prognosis and goals of care, are extremely beneficial to terminally ill patients and their families. However, given the context, healthcare professionals may find it challenging to initiate and facilitate such conversations. Hence, it is critical to improving the available communication strategies to enhance end-of-life communication practices. Aim: To summarise the end-of-life communication strategies recommended for healthcare professionals, identify research gaps and inform future research. Design: A scoping review performed in accordance with the Arksey and O’Malley framework. Data sources: A literature search was conducted between January 1990 and January 2022 using PubMed, CINAHL, Embase, PsycINFO, Web of Science, Scopus, Cochrane Library and China National Knowledge Infrastructure databases and Google, Google Scholar and ProQuest Dissertations & Theses Global. Studies that described recommended end-of-life communication strategies for healthcare professionals were included. Results: Fifty-nine documents were included. Seven themes of communication strategies were found: (a) preparation; (b) exploration and assessment; (c) family involvement; (d) provision and tailoring of information; (e) empathic emotional responses; (f) reframing and revisiting the goals of care; and (g) conversation closure. Conclusions: The themes of communication strategies found in this review provide a framework to integrally promote end-of-life communication. Our results will help inform healthcare professionals, thereby promoting the development of specialised training and education on end-of-life communication.

Open communication between patients and relatives about illness & death in advanced cancer—results of the eQuiPe Study

“…Conversely, research has shown that poor communication during the caregiving period is associated with higher levels of depression [ 11 ], increased feelings of guilt and regret [ 12 ], and more complicated grief experiences [ 11 , 13 ] among relatives during the bereavement period. These results suggest that communication plays a role in influencing the emotional well-being of relatives following the patient's death [ 14 , 15 ].…”

Patients’, families’ and healthcare providers’ perspectives on end-of-life communication in Chinese hospital settings: A qualitative study protocol

“…Our previous review of the international literature on end-of-life communication strategies emphasised the imbalance between the amount of evidence from Anglo-Saxon and non-Anglo-Saxon nations, which hinders a thorough comprehension and comparison of end-of-life communication in various sociocultural situations [ 21 ]. Moreover, recent research findings reinforce the influence of Chinese culture and philosophy on end-of-life communication.…”

Nurses' Subjectivity in Patient-Centered Communication for End-of-Life Patients

“…Discussions regarding end of life are not always welcome in a death-averse social context, but when hospice caregivers initiate these conversations and conduct them appropriately, they have the potential to drastically change a dying person's illness experiences 3 . Patient-centered communication in end-of-life care can increase treatment satisfaction, reduce the use of aggressive and costly medical services, alleviate the experience of bereavement, and ultimately improve patients' quality of life 4 …”

“…However, there are several limitations to patient-centered communication in the nursing care of end-of-life patients. Difficulties in patient-centered communication with end-of-life patients arise from potential emotional and personal impacts, communication skills and training, language and cultural barriers, time constraints, ethical dilemmas, interprofessional collaboration challenges, and the emotional burdens imposed on nurses 4,5,8 . Although subjectivity is inherent in all human interactions, it becomes particularly important for nurses in patient-centered communication 9 .…”

“…3 Patient-centered communication in end-of-life care can increase treatment satisfaction, reduce the use of aggressive and costly medical services, alleviate the experience of bereavement, and ultimately improve patients' quality of life. 4 Nurses' patient-centered communication competencies are essential for dignified end-of-life support. Numerous studies have confirmed that the quality of nurses' communication competency has a very strong correlation with the quality of end-of-life care.…”