Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

Abstract

Background End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. Methods The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals ( n = 14) from the wards. The analysis followed Spradley’s ethnosemantic analysis. Results The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a “here-and-now” status of the patient’s disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient’s and relatives’ thoughts and wishes concerning EOL, which allowed long-term care planning. Conclusion This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.

“It’s given me confidence”: a pragmatic qualitative evaluation exploring the perceived benefits of online end‐of‐life education on clinical care

“…The modules provided a framework by which health professionals could proactively respond to patient and carer needs. Participant responses in our study are consistent with other research that identifies a need for communication skills training, how to best care for family carers and improvement in multidisciplinary team communication about patient and carer needs [ 33 , 37 ]. Since its launch, more than 20,000 health professionals have registered with EOLE with over 36,000 module completions, indicating an interest in this general level of education about end-of-life care.…”

“…Enhancing health professionals’ ability to initiate these conversations is vital as patients don’t always speak up about approaching end of life, assuming the health professional will initiate this [ 35 , 36 ] Engaging in end-of-life care with patients has been identified as one of the most challenging but most important considerations for health professionals when caring for people at the end of life. [ 37 – 39 ]. Although communication skills training is included in most health professional education, minimal time is spent on how to broach end-of-life conversations [ 7 , 21 , 40 ].…”

Medical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey study

“…Additionally, it showed that some physicians consider hastening the end of life, even without explicit patient requests, as an act of mercy [29]. Our study found very little conversation takes place between physicians, patients and family members on the dying process and end-of-life decisions, a nding in line with previous studies from countries like the United States and Denmark [30]. It is possible these ndings represent a rmly-engrained paternalistic culture which persists among Colombian health professionals.…”

The Surprise Question and Serious Illness Conversations: A pilot study

“…7,15 Doctors are often expected to initiate SICs and nurses to provide emotional comfort, address concerns, and act as support persons. 7,10,14 All these barriers speak to the need for a coordinated interprofessional team approach to SICs. 15 The present study aims to address some of these barriers by promoting a coordinated interprofessional team approach to SICs through a quick and efficient collaborative method for identifying patients for SICs.…”