It's Time to Train All Doctors on How to Talk to Patients About End-of-Life Care

"They wanted all the support they could get, including palliative care and hospice at the appropriate times. But instead of partnering with her around his decline, acknowledging his decreased cognitive ability to participate in decisions, and revisiting the shared sense of what had been most important to him over time, the well-intentioned medical team focused on offering more interventions and didn’t acknowledge his dying process. She was told he was not eligible for hospice or palliative care.

She asked me: “How can this be?” Sadly, this is more common than you might think. A recent national poll found that although 99% of the physicians feel end-of-life and advance care planning discussions are important, nearly half reported they do not know what to say and less than a third reported any prior training for these conversations. These findings are not surprising considering a 2011 study found that 45% of those becoming oncologists reported having no explicit training in end-of-life communication.

 We know effective end-of-life communication can make a meaningful difference for seriously ill patients and their families, allowing patient goals and wishes to be aligned with treatment choices....Would end-of-life communication skills training have helped the doctor treating my neighbor’s husband provide more effective care? Very likely. Discussions about one’s goals of care near the end of life are high stakes and often complex....These efforts teach stepwise approaches, like assessing a patient’s current understanding of their disease before giving difficult news, skilled techniques, like focused listening for hints of emotion or distress, and specific phrases, like “tell me more” for an empathic approach. Experts are also beginning to emphasize formal mentored skills practice with increasing focus on role play, with and without actors...In a similar communication course at my own institution, doctors training in geriatrics, hospice and palliative medicine, pulmonary/critical care, and hematology/oncology report increasing their use of certain facilitating phrases like “I wish things were different” and identify specific, personalized goals for continued improvement. A project at Harvard has developed a Serious Illness Communication Guide and training course to trigger and train physicians to have more effective and timely discussions."

It's Time to Train All Doctors on How to Talk to Patients About End-of-Life Care: