title: Three principles to improve clinician communication for advance care planning: overcoming emotional, cognitive, and skill barriers.
abstract: BACKGROUND
  Medical care of patients with life limiting illness remains fraught with serious deficiencies, including inadequate advance care planning, delayed hospice referral, and continued delivery of aggressive treatment that is overtly counter to patients' preferences.
  
  
  OBJECTIVE
  This paper describes clinicians' emotional, cognitive, and skill barriers to shared decision-making with seriously ill patients and their loved ones.
  
  
  METHODS
  Thematic literature review.
  
  
  RESULTS
  Based on a literature review, as well as clinical and educational experience, we articulate three principles to address these barriers and guide future professional communication training for advance care planning.
  
  
  CONCLUSIONS
  We argue that these barriers must be overcome before deficiencies in end-of-life care can be fully ameliorated.
authors.affiliation: Long Island Jewish Medical Center, New Hyde Park, New York, USA. weiner@lij.edu
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Weiner
authors.forename: Steven A
authors.initials: SA
authors.lastname: Cole
mesh_terms: D032722:Advance Care Planning; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D004501:Education, Medical; D004506:Education, Nursing; D006801:Humans; D009723:Nurse-Patient Relations; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000523:psychology / Q000592:standards*