Interventions for interpersonal communication about end of life care between health practitioners and affected people

Ryan, Rebecca; Connolly, Michael; Bradford, Natalie; Henderson, Simon; Herbert, Anthony; Schonfeld, Lina; Young, Jeanine; Bothroyd, Josephine I; Henderson, Amanda

doi:10.1002/14651858.cd013116.pub2

Cited by 19 publications

(16 citation statements)

References 262 publications

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“…GPs express the di culties of EOL-communication between patients and health care providers as described by previous research [14]. The fear to destroy hope and to deteriorate the patients' emotional condition are the most important challenges mentioned.…”

Section: Discussionmentioning

confidence: 94%

Increasing challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

Villalobos

Korezelidou

Unsöld

et al. 2023

Preprint

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Background The timely initiation of end-of-life (EOL) conversations followed by advance care planning (ACP) is considerered best practice for patients with advanced cancer and therefore recommended in oncological guidelines. General practitioners (GPs) play a key role in the coordination of EOL-care and often claim that they have also the reponsibility to initiate the necessary conversations. Nonetheless, the content of these conversations are rarely a subject of communication between GPs and oncology specialists but crucial for timely integration of palliative care. The aim of this study is to explore the GPs‘ perspectives on initiation and conduction of EOL-conversations in patients with metastatic lung cancer and how they perceive the interaction with the oncologists of a cancer center. Methods Qualitative design with in-depth interviews with GPs that refer patients with metastatic lung cancer to a cancer center; thematic analysis following Braun and Clarke. Results We identified three main themes: timing and conduction of EOL-conversations, factors influencing EOL-conversations, and modes of GP-oncologist interaction. All themes showed important and increasing challenges in regard to communication strategies or procedures within the cancer center and between general practitioners and oncologists. Aside from the elucidated challenges of EOL-communication, new problems arise from the difficulties in keeping pace with advances in oncology and the increasing prognostic uncertainty. Additionally, the lack of standardized communication in EOL-topics between GPs and oncologists is underlined. Options in the mode of interaction include written information in reports or digital platforms and direct phone calls. Conclusions Because of the growing complexity in modern oncology, strategies for improvement in GP-oncologist interaction have to consider information about therapeutic advances and prognosis of patients. The increasing prognostic uncertainty hazards the adequate provision and conduction of EOL-conversations and thus, the timely integration of palliative care. As a consequence, a trustful personal interaction that includes direct contact via phone calls between GPs and oncologists should be encouraged.

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Section: Discussionmentioning

confidence: 94%

Increasing challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

Villalobos

Korezelidou

Unsöld

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Finally, the ICU physician is also best qualified to explain to the patient and family what ICU care can or cannot achieve, and what the possible consequences of a stay in the ICU might be. Several previous publications have highlighted the importance of communication and discussions surrounding goals of care in critically ill patients [ 30 – 33 ]. The majority of the sample of French ICU practitioners surveyed in this study were in agreement with this, yet it is telling that they continue to report this as an unmet need, highlighting the fact that there remains room for improvement in terms of goals-of-care discussions, both before and during ICU admission.…”

Section: Discussionmentioning

confidence: 99%

Non-beneficial admission to the intensive care unit: A nationwide survey of practices

et al. 2023

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Introduction In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations. Methods ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years’ experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from “Strongly disagree” to “Strongly agree”. Results Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient’s history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient’s overall healthcare goals was hailed as a means to prevent non-beneficial admissions. Conclusion The results of this survey suggest that joint discussions should take place during the patient’s healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed “non-beneficial”.

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“…Our findings thus support existing research on the importance of effective information and communication for relatives at the end of life. [2][3][5][6][8][9]11,[20][21][22][23] This includes research that evidences the benefits of using information pamphlets in end-of-life care for relatives' experiencing bereavement. [24][25][26] Other benefits highlighted by the study include the guide's effort to de-medicalise death and dying, thus contributing to a growing trend emphasizing the social nature of death and dying.…”

Section: Discussionmentioning

confidence: 99%

Deathbed Etiquette – The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings

et al. 2023

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Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a ‘Deathbed Etiquette’ guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words ‘death’ and ‘dying’ were identified. Most participants also expressed reservations about the title, with the word ‘deathbed’ found to be old-fashioned and the word ‘etiquette’ not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for ‘mythbusting’ death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The ‘Deathbed Etiquette’ guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.

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Interventions for interpersonal communication about end of life care between health practitioners and affected people

Abstract: Trusted evidence. Informed decisions. Better health.

Cited by 19 publications

References 262 publications

Increasing challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

Increasing challenges of general practitioner-oncologist interaction in end-of-life communication: a qualitative study

Non-beneficial admission to the intensive care unit: A nationwide survey of practices

Deathbed Etiquette – The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings

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