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.
