The troubles of telling: managing communication about the end of life

Qual Health Res. 2014 Feb;24(2):151-62. doi: 10.1177/1049732313519709. Epub 2014 Jan 27.


Communication about palliative care represents one of the most difficult interpersonal aspects of medicine. Delivering the "terminal" diagnosis has traditionally been the focus of research, yet transitions to specialist palliative care are equally critical clinical moments. Here we focus on 20 medical specialists' strategies for engaging patients around referral to specialist palliative care. Our aim was to develop an understanding of the logics that underpin their communication strategies when negotiating this transition. We draw on qualitative interviews to explore their accounts of deciding whether and when to engage in referral discussions; the role of uncertainty and the need for hope in shaping communication; and their perceptions of how patient biographies might shape their approaches to, and communication about, the end of life. On the basis of our analysis, we argue that communication is embedded in social relations of hope, justice, and uncertainty, as well as being shaped by patient biographies.

Keywords: communication; end-of-life issues; interviews, semistructured; palliative care; uncertainty.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Attitude to Death*
  • Communication*
  • Emotions
  • Humans
  • Interviews as Topic
  • Palliative Care*
  • Professional-Patient Relations*
  • Terminal Care*