Palliative care physicians’ experiences of end-of-life communication: A focus group study

Abstract

The aim of this study was to explore palliative home care physicians' experiences regarding end-of-life breakpoint communication (BPC). This is a qualitative study where focus group interviews were conducted and analysed using qualitative content analysis. The results show that the participants saw themselves as being responsible for accomplishing BPC, and they were convinced that it should be regarded as a process of communication initiated at an early stage, i.e. proactively. However, BPC was often conducted as a reaction to the patient's sudden deterioration or sometimes not at all.The barriers to achieving proactive BPC included physicians' uncertainty regarding the timing of BPC, primarily due to difficulties in prognostication in terms of time of death, and uncertainty as to what BPC should include and how it should best be approached.Furthermore, there was insufficient documentation regarding previous BPC, which impeded proactive BPC. Although our study shows that physicians are ambitious when it comes to the communication of information to patients and families, there is a need for further training in how to conduct BPC and when to initiate the BPC process.Furthermore, there should be documentation that different professionals can access as this would appear to facilitate a proactive BPC process. K E Y W O R D Scommunication, end of life, palliative care, physicians | INTRODUCTIONPalliative care should be introduced early in the disease trajectory to enable advanced care planning, thus affirming life and resulting in dying being regarded as a natural part of life (WHO, 2002). Planning endof-life care involves communication among professionals and patients and often the patient's family. Through different phases of a disease, every patient is entitled to receive understandable information, to be given the opportunity to ask questions and to discuss his/her prognosis and medical condition (Walczak, Butow, Bu, & Clayton, 2016; Worldwide Palliative Care Alliance, 2014). This is equally important in the approach towards death so that the patient has opportunity both to express his/her individual preferences regarding care and treatment as well as to achieve as high a quality of life as possible, even when Despite the studies highlighting the importance of communicating information regarding deterioration in a timely manner, this often does not happen. For BPC to be initiated and for the patient to be given the opportunity to communicate with the physician providing the treatment, more needs to be learnt about this specific type of communication. The physician is medically responsible for providing a diagnosis when disease-directed treatment is unlikely to prolong life and when palliative end-of-life care is optimal. Since the responsibility includes communicating this information, it is important to explore the physicians' experiences of BPC so as to understand their view of the process and so as to learn how BPC can be supported and initiated. | AIMThe aim of this study was to explore palliative home care...

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