Doctors struggle with conducting end-of-life conversations with their patients

A large study published in PLOS ONE identified common barriers doctors face in conducting end-of-life (EOL) conversations with their patients. 1040 doctors from various medical specialties participated in the study and only 0.01 % doctors reported no barriers to conducting EOL conversations with patients. 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. Asian-American doctors reported the most struggles (91.3%), followed by African Americans (85.3%), Caucasians (83.5%) and Hispanic Americans (79.3%) in conducting EOL conversations with their patients.

The biggest doctor-reported barriers to effective EOL conversations are

  • language and medical interpretation issues,
  • patient/family religio-spiritual beliefs about death and dying,
  • doctors’ ignorance of patients’ cultural beliefs, values and practices,
  • patient/family’s cultural differences in truth handling and decision making,
  • patients’ limited health literacy and
  • patients’ mistrust of doctors and the health care system.

The doctors’ ethnicity and medical subspecialty influenced their reported barriers. The biggest differences across sub-specialties were seen in Emergency Medicine, Neurology, Psychiatry and Anesthesia. Emergency Medicine doctors rated the patient/family’s limited health literacy barrier as being more problematic compared to doctors in general. Neurologists rated doctors’ ignorance of patients’ cultural beliefs, values and practices as a more problematic and cultural differences in truth handling and decision making as less problematic as compared to doctors in general. Psychiatrists stated that cultural differences in truth handling and decision-making were more problematic compared to doctors in general. Anesthesiologists felt that patient/family’s limited health literacy was less of a barrier compared to doctors in general.

Doctors report struggles with conducting effective EOL conversations with all patients and especially with those whose ethnicity is different from their own.Doctors need to be trained to work effectively with patients and families from diverse religio-spiritual backgrounds and to consult and partner with chaplains and community spiritual leaders in providing necessary support to seriously ill patients and families to facilitate quality EOL decisions.

So what is the solution?

Patients need to take an active role and think about and plan for the care they want at the end of life. We urge patients to join our Letter Project and use our simple form to write a letter to your doctor about what matters most to you at the end of life. Write your letter now! Its free, easy and extremely important.
VJ Periyakoil
Twitter : @palliator

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  • Charlie

    Brilliant idea …excellent video …wonderful companion piece to the Conversation Project for educating our communities consumers and providers. Innovative way to raise these issues through both conversation and action. Here’s hoping our clinical communities will be receptive to receiving these important letters and finding them supportive when milestones on the life continuum of health are reached and consultation is needed to know the path forward in the person/families journey.
    Charlie

  • Glenda Magtanong

    The Letter Project is such a wonderful program. It is powerful, moving and erases the painful stigma attached to the words “advanced directive”! Thank you for bringing this information via this platform out to the world where cultural, ethnic and religious beliefs make it difficult for many to begin the process of thinking about their wishes, let alone articulating it. Your program not only help and guide those who are overwhelmed and uncomfortable but having the letters in many different languages removed barriers and expanded its reach. Thank you!