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Clinical practice guideline on palliative care for adults in the last days of life
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Question

What factors are associated with good communication between the patient, their family and close friends, and the attending clinicians in the last days of life?

Recommendations

  1. Foster an appropriate climate based on warmth, empathy, assertiveness, and active listening, paying special attention to non-verbal communication. As and when possible, find a physical space to safeguard privacy, and dedicate sufficient time, allowing questions to be asked and doubts resolved, and also time for reflection.
  2. Identify the communication needs and expectations of people at the end of life taking into account:
    • Whether they do or do not want someone in particular to be present when decisions are made.
    • Their current awareness of and knowledge about the end-of-life situation.
    • How much information they want regarding the process they are going through.
    • Their social, cultural, religious and spiritual preferences and needs.
    • Their fears and concerns.

 

Rationale

These recommendations aim to promote effective communication in the last days of life that would improve the drafting of the care plan and the quality of care provided. The recommendations, although they concern good clinical practice, are based on qualitative studies on the factors that influence good end-of-life communication.

Complete clinical question

For full information on this question (available in Spanish), see:
http://portal.guiasalud.es/guia-en-capas/gpc_612__atencion_paliativa_sud-2/#question-2

References

6. The goals of medicine. Setting new priorities. Hastings Cent Rep. 1996;26(6):S1-27.

22. National Institute for Health and Care Excellence. Care of dying adults in the last days of life. London: National Institute for Health and Care Excellence; 2015. [accessed 12 Oct 2018]. Available from: www.nice.org.uk/guidance/ng31.

49. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end- of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300(14):1665-73. DOI: 10.1001/jama.300.14.1665.

50. Anselm AH, Palda V, Guest CB, McLean RF, Vachon ML, Kelner M, et al. Barriers to communication regarding end-of-life care: perspectives of care providers. J Crit Care. 2005;20(3):214-23. DOI: 10.1016/j.jcrc.2005.05.012.

51. Aslakson RA, Wyskiel R, Thornton I, Copley C, Shaffer D, Zyra M, et al. Nurse-perceived barriers to effective communication regarding prognosis and optimal end-of-life care for surgical ICU patients: a qualitative exploration. J Palliat Med. 2012;15(8):910-5. DOI: 10.1089/jpm.2011.0481.

52. Gutiérrez KM. Experiences and needs of families regarding prognostic communication in an intensive care unit: supporting families at the end of life. Crit Care Nurs Q. 2012;35(3):299- DOI: 10.1097/CNQ.0b013e318255ee0d.

53. Jackson A, Purkis J, Burnham E, Hundt GL, Blaxter L. Views of relatives, carers and staff on end of life care pathways. Emerg Nurse. 2010;17(10):22-6. DOI: 10.7748/en2010.03.17.10.22.c7616.

54. Houttekier D, Witkamp FE, van Zuylen L, van der Rijt CC, van der Heide A. Is physician awareness of impending death in hospital related to better communication and medical care? J Palliat Med. 2014;17(11):1238-43. DOI: 10.1089/jpm.2014.0203.

55. Sullivan AM, Lakoma MD, Matsuyama RK, Rosenblatt L, Arnold RM, Block SD. Diagnosing and discussing imminent death in the hospital: a secondary analysis of physician interviews. J Palliat Med. 2007;10(4):882-93. DOI: 10.1089/jpm.2007.0189.

56. Generous MA, Keeley M. Wished for and avoided conversations with terminally ill individuals during final conversations. Death Stud. 2017;41(3):162-72. DOI: 10.1080/07481187.2016.1236850.

57. Odgers J, Fitzpatrick D, Penney W, Wong Shee A. No one said he was dying: families’ experiences of end-of-life care in an acute setting. Australian Journal of Advanced Nursing. 2018;35(3):21-31.

58. Park EM, Check DK, Yopp JM, Deal AM, Edwards TP, Rosenstein DL. An exploratory study of end-of-life prognostic communication needs as reported by widowed fathers due to cancer. Psychooncology. 2015;24(11):1471-6. DOI: 10.1002/pon.3757.

59. Nouvet E, Strachan PH, Kryworuchko J, Downar J, You JJ. Waiting for the body to fail: limits to end-of-life communication in Canadian hospitals. Mortality. 2016;21(4):340-56. DOI: 10.1080/13576275.2016.1140133.

60. Rodenbach RA, Rodenbach KE, Tejani MA, Epstein RM. Relationships between personal attitudes about death and communication with terminally ill patients: how oncology clinicians grapple with mortality. Patient Education and Counseling. 2016;99(3):356-63. DOI: 10.1016/j.pec.2015.10.010.

Recognising the last days of life
Shared decision-making and development of a care plan