Patients aren’t having enough serious illness conversations.
- 61% of Californians 65+ want to discuss end-of-life care with their doctor, but only 13% have.1
- In a 2010 survey of patients with CKD, 83.4% of patients didn’t understand what palliative care was and <10% had discussed end-of-life care with their physician in the last year.2
- In a 2017 survey of 1212 bereaved family members, 1 in 8 believed care in the last month of life was inconsistent with patient wishes. Inconsistent care was associated with worse clinician communication and quality of care.3
- In a 2002 survey of 1185 patients, only 41% of those who preferred comfort care reported that care was consistent with their preferences. Patients receiving care inconsistent with their preferences had significantly higher medical costs.4
Many physicians don’t receive adequate training in serious illness conversations.
- 99% of surveyed physicians believe that end-of-life conversations are important.5
- 75% believe they are responsible for initiating end-of-life conversations.5
- Only 29% report that they have formal training in end-of-life conversations.5
Communication skills training improves physicians’ likelihood and ability to have serious illness conversations.
- Communication skills training leads to more, earlier, and more comprehensive serious illness conversations.6
- Communication skills training has been shown to significantly improve physicians’:
- Likelihood to discuss and document goals of care and advance directives6,7
- Ability to discuss transition to palliative care8,9
- Ability to deliver bad news9,10
- Global communication skills8,10
- Empathic expression11,12,13,14,15
- Response to patient emotional cues9,10,11,12,13,15,16
- Checks for patient understanding12,13,14
- Patient-rated trust, perceived empathy, and communication7,15,17
- Likelihood to fully meet informational and emotional needs of patients’ family members18
- Burnout (emotional exhaustion, depersonalization, and sense of achievement)17
- Self-efficacy in performing and teaching serious illness conversations13,17,19,20
- The positive impact of communication skills training can endure at least 15 months.21
Serious illness conversations improve goal-concordance and care experience.
- Serious illness conversations are associated with:
- Higher likelihood of goal-concordant care7,22,23
- Higher patient-rated care experience7,22
- Lower likelihood of aggressive care24,25
- Increased likelihood and length of hospice stay24,25,26
- Lower rates of depression and anxiety in bereaved families22,24
Serious illness communication interventions can improve patient quality of life and outcomes.
- Serious illness communication interventions are associated with:
- Higher patient-rated quality of life27, 28,29
- Longer survival27
- Fewer depressive symptoms27,28,29
- Improved spiritual wellbeing29
- Lower health costs26
Differences among those with training and formal assessment systems are substantial.
Physicians who have had specific training on end-of-life conversations and those who report a formal system in place for assessing patients’ goals and wishes are different from their peers in some key ways.
For example, physicians who have had training in end-of-life conversations are more likely than those who have not to:
- Say it is extremely important for health care providers to have these conversations with their patients (59 percent vs. 47 percent);5
- Talk to patients 65 and older about issues related to advance care planning/end-of-life care once a week or more (79 percent vs. 69 percent);5
- Find conversations about end-of-life care to be rewarding (46 percent vs. 30 percent); and5
- Say they rarely or not too often feel unsure about what to say when having conversations about end-of-life care (60 percent vs. 52 percent).5
Compiled by Dana Farber Cancer Institute in association with VitalTalk.