Communication in palliative care: talking about the end of life, before the end of life

Postgrad Med J. 2016 Aug;92(1090):466-70. doi: 10.1136/postgradmedj-2015-133368. Epub 2016 May 6.


Increasing evidence demonstrates the benefits of early end-of-life care discussions with patients with life-threatening illness and their families. However, these conversations often do not occur. This review explores some of the many barriers faced by clinicians in relation to end-of-life care discussions, including prognostic uncertainty, fear of causing distress, navigating patient readiness and feeling unprepared for these conversations. The value of core clinical communication skills, potential strategies for improvement and areas for future research are also discussed. It is essential that clinicians offer patients facing life-threatening illness, and those close to them, the opportunity to discuss end-of-life issues in line with their information and decision-making preferences. With a growing and ageing global population, supporting both generalist and specialist providers of palliative care in this task is key. With careful preparation, fears of undertaking these discussions should not be a barrier to initiating them.

Keywords: Advance Care Planning; Communication; End-of-life care; MEDICAL EDUCATION & TRAINING; PALLIATIVE CARE.

Publication types

  • Review

MeSH terms

  • Advance Care Planning*
  • Communication
  • Decision Making
  • Evidence-Based Medicine
  • Family
  • Humans
  • Palliative Care* / methods
  • Palliative Care* / psychology
  • Patient Care Planning
  • Patient Participation
  • Physician-Patient Relations*
  • Practice Guidelines as Topic
  • Prognosis
  • Quality of Life
  • Terminal Care / methods*
  • Terminal Care / psychology
  • Terminally Ill / psychology*