title: Communication in palliative care: talking about the end of life, before the end of life.
abstract: Increasing evidence demonstrates the benefits of early end-of-life care discussions with patients with life-threatening illness and their families. However, these conversations often do not occur. This review explores some of the many barriers faced by clinicians in relation to end-of-life care discussions, including prognostic uncertainty, fear of causing distress, navigating patient readiness and feeling unprepared for these conversations. The value of core clinical communication skills, potential strategies for improvement and areas for future research are also discussed. It is essential that clinicians offer patients facing life-threatening illness, and those close to them, the opportunity to discuss end-of-life issues in line with their information and decision-making preferences. With a growing and ageing global population, supporting both generalist and specialist providers of palliative care in this task is key. With careful preparation, fears of undertaking these discussions should not be a barrier to initiating them.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, & Rehabilitation, London, UK.
authors.forename: Lisa Jane
authors.initials: LJ
authors.lastname: Brighton
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, & Rehabilitation, London, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bristowe
mesh_terms: D032722:Advance Care Planning; D003142:Communication; D003657:Decision Making; D019317:Evidence-Based Medicine; D005190:Family; D006801:Humans; D010166:Palliative Care / Q000379:methods / Q000523:psychology; D010347:Patient Care Planning; D010358:Patient Participation; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011788:Quality of Life; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology*
keywords: Advance Care Planning; Communication; End-of-life care; MEDICAL EDUCATION & TRAINING; PALLIATIVE CARE