TORONTO – They have a hard time with a poor diagnosis, they’re anxious, and even in denial: a new Canadian study suggests that a family’s difficulty in accepting their loved one’s grim fate is often a barrier to end-of-life care discussions.
After surveying more than 1,200 doctors and nurses across the country, scientists at McMaster University in Hamilton, Ont., listed the key obstacles standing in the way of starting these conversations.
Health care staff from B.C., Alberta, Ontario, Quebec and Newfoundland were all polled for the study published Monday in the journal JAMA Internal Medicine.
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Doctors felt the following issues were obstacles to end-of-life care discussions:
- families grappling with a poor prognosis
- having trouble grasping the limitations and complications linked to life-sustaining treatments
- considering aggressive options to keep their loved one alive at the expense of their comfort
- family members disagreeing about their priorities
- patients not being in the right capacity to make sound decisions.
End-of-life care discussions typically focus on making decisions about hospital care, and if patients are comfortable with using life-sustaining treatments when they’re seriously ill.
“There are two issues here: we need to normalize conversations about death and dying so that people can be more comfortable having advance care planning discussions within families before there’s a crisis,” Dr. John You, lead author of the study and a medicine professor, said in a statement.
“And clinicians need to be highly skilled and sensitive communicators, with better training and tools like conversation guides to enable and support these conversations,” he said.
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Last November, You and his team published a list of five things patients felt doctors should address in end-of-life discussions.
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In You’s research, he sought feedback from patients admitted to nine different hospitals in B.C., Alberta, Ontario and Quebec. More than 230 adults in hospital with a serious illness and 205 family members were involved in the study.
The Top 5 things to discuss in end-of-life care according to the study’s participants were:
- preferences of care in event of life-threatening illness
- patient values
- prognosis of illness
- fears or concerns
- additional questions regarding care
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You’s hoping that his findings will help improve end-of-life care for patients in hospital. It’s becoming a hot-button issue as some patients are attempting to take their end-of-life care into their own hands.
Read the latest findings here.
carmen.chai@globalnews.ca
Follow @Carmen_Chai
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