End-of-life communication: let’s talk about death

Abstract

While some deaths occur suddenly, the majority of deaths are predictable, occurring after a period of chronic illness. All doctors will at some stage be required to care for patients who are dying and communication is the key to doing this well. Sadly, all too often this is not achieved. Indeed, more than half of NHS complaints are associated with care of the dying, many of them focused on information and communication. 2 Poor communication at the end of life can cause deep distress, both for the patient and their loved ones, and may adversely impact on post-bereavement outcomes. This was highlighted recently by the independent review into the Liverpool Care Pathway (LCP), an integrated care pathway designed to be used in the last days of life, and the subject of intensive media criticism following reports of poor end-of-life care. The independent review identified inadequate communication as responsible for much of the controversy and unhappiness surrounding care of the dying. 3 On the other hand, good communication allows patients and their families to make informed decisions about healthcare, to prepare for the future, and to express and meet their preferences for end-of-life care.