Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

ABSTRACT

Initiating end-of-life (EoL) discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at EoL. We surveyed healthcare practitioners to elicit their exposure to and confidence in EoL discussions and to better understand factors that enable or challenge the initiation of discussions in Australian healthcare settings. Thematic analysis identified that EoL discussions could be emotionally burdensome for healthcare practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between healthcare practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role play and mentoring particularly for younger nurses and doctors were identified. Specific training in EoL communications should target undergraduates and new healthcare practitioners

Acknowledgements

We would like to thank the nurses and doctors who took the time to complete the survey and expand on their valuable views to help us understand the issues facing their end-of-life communications. We would like to also thank Dr Marlee King (MK) from Western Sydney University for her assistance with data analysis.

Authors’ contributions

Study design: MC, EL, MN, ST, KH; Study advertising/recruitment: EL, MC, SS, MN, KH; Data collection: SS, MN, MC, EL; Data analysis: ST, MC, EL; First draft of manuscript: ST, MC, EL; Revision of drafts and approval of final version of manuscript: All authors.

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Additional information

Funding

This work was supported by the National Health and Medical Research Council of Australia [NHMRC grant No. 1054146]. The funding body had no role in the study design, survey content or execution, data analysis or interpretation, manuscript writing or decision to publish.