Doctor-Patient Communication May Improve End-of-Life Care

Prognosis and chance to ask questions were important to patients nearing the end of life

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) As older people with illnesses near the end of their lives, patients and families face tough personal and medical decisions. But clear and detailed doctor-patient communication could improve end-of-life care for these patients, a new study found.

Some doctors often do not fully explain patient medical outlook or give the patient a chance to express concerns and ask questions, the study found.

The authors of the recent study found that end-of-life care was not meeting the expectations of many older patients.

John J. You, MD, and colleagues surveyed 233 older Canadian adults in the hospital with serious illnesses about what was most important to them in their treatment. The research team also surveyed 205 family members of these patients.

The study authors based their work on published guidelines for doctors providing end-of-life care. The guidelines were from the Royal College of Physicians.

These guidelines stressed giving the patient a realistic medical outlook and knowing the patient’s preferences for care when they have a life-threatening illness or event. Another main point is explaining the benefits, like prolonged life, and risk of death or side effects from life-sustaining treatments. The guidelines also cover advising patients on how to organize legal and financial affairs and giving the patient a chance to express fears and concerns.

Dr. You and team surveyed patients and family members based on these guidelines. They found that, on average, caregivers covered only 1.4 of the 11 total guidelines.

Patients reported feeling more satisfied with doctors who asked more questions, the authors found.

The authors concluded that doctors and patients are often not on the same page regarding end-of-life care.

"Our results suggest that [agreement] between preferences and prescribed goals of care, as well as satisfaction with end-of-life communication, increase with the number of elements discussed.”

Dr. You, of the Michael G. DeGroote School of Medicine at McMaster University in Ontario, Canada, and colleagues found five elements patients and their families rated as most important:

  • Patients and families wanted to discuss preferences for end-of-life care. For instance, patients should tell their doctors how to proceed if they take a turn for the worse, the study authors wrote.
  • Patients rated communicating “patient values” to their doctor as very important. Patient values refer to what a patient feels is important, such as sustaining life for as long as possible or maintaining independence.
  • Family members rated a clear statement of prognosis by the doctor as the most important end-of-life care element. Prognosis is the likely outcome of a medical condition. Prognosis was discussed with 10 percent of patients and 17 percent of family members, according to the study.
  • Survey respondents also stressed communicating fears and concerns to a doctor.
  • Patients and family members surveyed also reported benefit from asking a doctor questions.

The study was published online Nov. 3 in the Canadian Medical Association Journal.

The Canadian Institutes of Health Research, the Michael Smith Health Services Research Foundation, Alberta Innovates and others supported the study. The authors disclosed no conflicts of interest.

Review Date: 
November 3, 2014
Last Updated:
November 12, 2014