Talking about death can often be uncomfortable, even for experienced healthcare professionals. However, it’s important to be able to have these difficult conversations with patients and their families in order to provide high quality care. This year, during Dying Matters week in May, the Medical Protection Society ran a survey to gather the views of 370 doctors on matters concerning death – here’s what they found
Caring for someone who is terminally ill is, understandably, a very emotional and distressing time for everyone involved. Sometimes families can have unrealistic expectations as to what can be achieved in relation to the type of care and support available to their loved one. For example, one doctor who responded to the survey said that, although the family had several meetings with senior staff and the palliative care team, they seemed to be resistant and unwilling to understand or accept the terminal diagnosis, even though they had been aware of it for months beforehand. This, ultimately, led to the situation frequently feeling hostile as they had very different opinions on how the things should be handled, which made it more difficult to manage.
Another member said the fear of litigation, and lack of trust from patients’ families, was ever-present: “The medical and nursing profession all fear being sued by angry families who have unrealistic expectations and strongly believe that we are withholding treatments in order to ration scarce resources for other, ‘more deserving’, patients.”
A doctor may think they have communicated essential information effectively, and that the patient has understood fully but, in circumstances where emotions are running high, it is essential to check they have grasped the full situation in order to avoid misunderstandings.
The General Medical Council’s report Treatment and Care Towards the End of Life states, “It is important that you, and other members of the healthcare team, acknowledge the role and responsibilities of people close to the patient. You should make sure that, as far as possible, their needs for support are met and their feelings respected, although the focus of care must remain on the patient.”
Take time to communicate well
Before approaching a patient or their family to discuss end of life care, healthcare professionals should try to anticipate how patients and their families may react, and consider the timing and location of where the discussions should take place. Such conversations cannot be rushed and should take place in calm atmosphere.
The survey reveals that just over half (55%) of doctors who responded feel comfortable discussing dying with their patients. Being comfortable talking about end of life issues allows healthcare professionals to have necessary and difficult conversations with patients, and their families, about how they want to be cared for in their final days. The quality of communication is of key importance. We know that, when patients and their families feel they have been consulted and involved in decisions, the process of death and grieving can be less burdensome.
However, in order for doctors to have these difficult conversations with their patients and their families they need to have adequate time and appropriate settings . The Medical Protection survey reveals that seven-in-ten doctors (72%) do not feel they have adequate time to discuss end of life care with their patients.
With pressures on the NHS continuing to impact on doctors’ ability to spend as much time talking to their patients as they would wish, Medical Protection highlights that employers need to pay attention to ensuring their doctors have sufficient time to spend with patients near the end of their lives. It is also important that medical staff have the skills they need and feel that they are well supported.
It should be remembered that the death of a patient can also have an important impact on doctors and other healthcare professionals and they should not be afraid to seek help in these circumstances. Talking through these feelings with a close friend or colleague can be helpful. Doctors can also contact their Medical Defence Organisation if they are concerned that the quality of their care may be called into question.