title: Challenges in end-of-life communication.
abstract: OBJECTIVE
  The purpose of this review is to give an overview of challenges that have been addressed in recent research in end-of-life communication.
  
  
  RESULTS
  Diversity of difficulties that may occur in communication about end-of-life issues has been showed. The emotional quality of this communication requires special skills from professionals involved. Studies showed that physicians and medical students are often overstrained and avoid end-of-life discussions. Health professionals and patients are often ambivalent about end-of-life discussions. Nevertheless, professionals are expected to initiate these in an honest, needs-oriented way. Patient preferences are difficult to infer and have to be assessed explicitly and regularly. Studies showed that the emotional impact of end-of-life discussions can lead to a high burden or avoidance of professionals. Interdisciplinary, multi-professional work can support health professionals in end-of-life care but often structural barriers obstruct possible benefits.
  
  
  CONCLUSIONS
  Health professionals need to initiate end-of-life communication in a sensitive way. Specific demands for health professionals in end-of-life communication are to differentiate own emotions and life events from those of patients and to deal with both adequately. Moreover, structural aspects can lead to difficulties between different specialties, professions and sectors, which can have a negative impact on adequate care for patient and relatives. Special efforts for improvement are needed.
authors.affiliation: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Maren
authors.initials: M
authors.lastname: Galushko
authors.forename: Vanessa
authors.initials: V
authors.lastname: Romotzky
authors.forename: Raymond
authors.initials: R
authors.lastname: Voltz
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D004645:Empathy; D006301:Health Services Needs and Demand; D006801:Humans; D010166:Palliative Care / Q000941:ethics*; D010348:Patient Care Team; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000941:ethics*