How to Talk About Attitudes Toward the End of Life: A Qualitative Study

Abstract

To individually plan end-of-life care, open communication about a person’s preferences and attitudes toward the end of life can facilitate dignity and quality of life in patients and relatives. To improve communication, structured guiding tools might be used as door openers. However, most tools focus on care preferences and decisions without assessing the person’s underlying attitudes in detail. This study aims to get insights into specific requirements and conditions for communication about the end of life in various end-of-life care settings. Four focus groups were conducted with volunteers and professionals from nursing and psychosocial care (16 females, 2 males) working in hospice and palliative care and long-term care settings in Germany. A semistructured interview guideline on experiences and aspects associated with end-of-life conversations was used. Interviews were audiotaped, transcribed verbatim, and analyzed by a content analytic approach. Having end-of-life discussions primarily depended on a pleasant atmosphere, trusting bonds between conversation partners, and professional attitudes of staff members. Nursing home staff felt obligated to initiate conversations, but some reported insecurities doing so. Starting “early,” including relatives, and having continuous discussions seemed beneficial for end-of-life conversations. Implementing conversations into existing care structures and using low-threshold impulses to start conversations were helpful. Individualized approaches should be preferred. Each staff member can be a partner in detailed conversations about end-of-life attitudes, but some felt unprepared doing so. Further skill training concerning end-of-life discussions is needed. Communication might be facilitated by open-format tools using low-threshold impulses when conditions of the care setting are considered.

Use, Usability, And Impact of A Tool To Support Conversations About End-of-Life Preferences In Residential Elder Care – A Qualitative Study of Staff Experiences

“…The DöBra cards were found to be useful to strengthen person-centered care provision and rapport both during and after EOL conversations. This is in contrast to a recent study by Groebe et al [44], in which some care staff considered EOL conversation tools to be counterintuitive to an individualized care approach. It may be that the physical format of the DöBra cards better allowed residents and/or relatives to be actively involved in directing the discussion than other conversation tools, as the cards they choose served as route markers for mapping the discussion, with as much -or little -commentary as residents and/or relatives wished.…”

Positive attitudes to advance care planning – a Norwegian general population survey

“…However, that might run contrary to the idea of ACP being held while persons are still able to communicate [ 22 ]. In addition, health care personnel have indicated that ACP close to dying is “too close and tense” and a peaceful atmosphere is needed [ 43 ]. Health care personnel may worry about causing patients harm by having untimely ACP discussions [ 44 ] and this can increase the uncertainties about when ACP is timely.…”

Physicians’ approach to end of life care: comparison of two tertiary care university hospitals in Lebanon

“…Updating available course offerings could also help to promote patient-centric considerations of preferences in terms of EOL care and dying. Training should address the need for early individualized approaches to EOL discussion, and their integration into existing care structures [ 23 ], which would ultimately promote favorable attitudes towards EOL practices among physicians [ 18 ].…”

“…EOL care is an immature concept in Lebanon with little to no guidance provided to physicians in this regard. This could explain the attitude of Lebanese physicians seeing as insecurities among medical care staff often lead to delayed discussions with either patients or their relatives [ 23 ]. Shared decisions in the context of EOL also reflect societal, educational, cultural, and religious values in both patients and physicians.…”