Abstract
BackgroundOlder patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. This study examines older patients’ attitudes towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.MethodsA secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach.ResultsThemes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability, time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained that information was only provided about the physician's preferred treatment.ConclusionsA variety of experiences and attitudes regarding disclosure and participation in decision-making were reported from each country, suggesting that communication preferences are highly individual. It is important that physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear understanding of treatment options. This idealized situation was often not reflected in patients’ experiences.
Highlights
Older patients often experience sub-standard communication in the palliative phase of illness
The needs of older patients are often neglected during end-of-life (EoL) care [1]
Poor patient-physician communication influences patients’ understanding of their advanced condition, participation in treatment decisions and satisfaction with services [3,4,8]. These issues might be pertinent for all patients they are relevant for older patients whose characteristics suggest specific communication needs
Summary
Older patients often experience sub-standard communication in the palliative phase of illness. Due to the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors which influence older patients’ communication with physicians. Older patients have less access to specialist palliative care services than younger patients and are more likely to have their treatment needs under-assessed [1,2]. Poor patient-physician communication influences patients’ understanding of their advanced condition, participation in treatment decisions and satisfaction with services [3,4,8]. These issues might be pertinent for all patients they are relevant for older patients whose characteristics suggest specific communication needs. Older patients suffer more multiple morbidities, leading to greater health care needs [1], and are more likely to suffer from impaired cognitive functioning
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