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Marjorie D. Wenrich, MPH; J. Randall Curtis, MD, MPH; Sarah E. Shannon, RN, PhD; Jan D. Carline, PhD; Donna M. Ambrozy, PhD; Paul G. Ramsey, MD

Arch Intern Med. 2001;161:868-874.

Background  Efforts to improve communication between physicians and dying patients have been unsuccessful, and guidelines for improving patient-physician communication about end-of-life care are based primarily on expert opinion. This study assessed which aspects of communication between patients and physicians are important in end-of-life care.

Methods  Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care professionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as one of the most important domains. Analyses of components important in communicating with dying patients and their families were performed.

Results  The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way, listening to patients, encouraging questions from patients, and being sensitive to when patients are ready to talk about death. Within these components, subthemes emerged that provide guidelines for physicians and educators. Dying patients also identified the need to achieve a balance between being honest and straightforward and not discouraging hope.

Conclusions  Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to approach communication about end-of-life care as a spectrum that requires attention from the time of a terminal diagnosis through death.

From the School of Medicine (Ms Wenrich and Dr Ramsey), the Division of Pulmonary and Critical Care Medicine, Department of Medicine (Dr Curtis), the Department of Health Services (Dr Curtis), the Department of Biobehavioral Nursing and Health Systems, School of Nursing (Dr Shannon), and the Department of Medical Education (Drs Carline and Ambrozy), University of Washington, Seattle.

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