What to discuss when death is near

A study has identified the top five things doctors should discuss with hospitalised patients and their families as they near the end of their lives.

The most important aspects to discuss are preferences for care in the event of life-threatening illness; patient values; prognosis of illness; fears or concerns and additional questions regarding care.

"However, we found that these elements are infrequently discussed and that concordance between preferred and prescribed goals of care is low," the authors of the study stated.

Current US guidelines list 11 key elements for health care providers to discuss regarding end-of-life care.

However, these are based mainly on expert opinion and not on patient and family feedback.

A team of researchers surveyed 233 hospitalised older adults with serious illnesses and 205 family members about the importance of the 11 guideline-recommended elements of end-of-life care.

The patients had been admitted to nine hospitals in British Columbia, Alberta, Ontario and Quebec.

Patients reported that of the 11 key elements, an average of only 1.4 had been discussed with the health care team within the first few days of admission to hospital.

"The more elements of care that physicians discussed with patients, the higher the satisfaction that they and their families reported regarding care received, and the higher the concordance between preferred and prescribed goals of care," the authors noted.

"Our findings could be used to identify important opportunities to improve end-of-life communication and decision-making in the hospital setting," said John You, associate professor at McMaster University's Michael G. DeGroote School of Medicine.

They hope that their findings will help improve end-of-life care for patients in hospitals across the globe.

The study appeared in the Canadian Medical Association Journal.