Doctors 'need to start early conversations’ about dying

A new report exploring the reasons why doctors and other healthcare professionals find it hard to talk to patients about dying has encouraged them to be more proactive.

Talking about dying: How to begin honest conversations about what lies ahead, published by the Royal College of Physicians, says that doctors should talk to people who could die within 12 months, who may be frail or terminally ill, and give them choices over their future care. However, based on conversations with doctors at all levels, patients and carers, it appears this rarely happens.

The barriers to talking about dying identified by doctors include: culture, with some physicians feeling that death could be perceived as a failure; confidence, with many doctors feeling uncomfortable initiating conversations about the future with patients; and practicalities, with confusion over whether hospital doctors or the patient’s GP should be having the conversation.

The General Medical Council says patients should be considered to be approaching the end of their life if they: are likely to die in the next year, have progressive, incurable conditions, have other conditions and are generally frail, have conditions that could cause death if there was a sudden deterioration or have life-threatening acute conditions caused by sudden catastrophic events.

But only a quarter of patients in these categories are given the chance to discuss the end of their life with a doctor, the report says, and those with heart failure, dementia and frailty are much less likely to be identified.

Andrew Goddard, president of the Royal College of Physicians, said: “This report is a big step forward in helping patients, relatives and doctors to talk honestly about death and dying. We must minimise the barriers in our systems and culture that prevent this from happening. This is not just about palliative care in the final days, but about having a series of conversations much earlier after a terminal diagnosis.”