How do we teach clinicians to talk about the end of life?

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Image credit: Doctor and patient – Government of Alberta. Creative Commons License 2.0 (Non-commercial No Derivatives). Source: Flickr

By Dr Lucy Selman Research Fellow (Qualitative Research in Randomised Trials) Centre for Academic Primary Care  University of Bristol

In a systematic review published this month, we identified 153 communication skills training interventions for generalists in end of life care. In randomised controlled trials, training improved showing empathy and discussing emotions in simulated interactions (i.e. with actor patients) but evidence of effect on clinician behaviours during real patient interactions, and on patient-reported outcomes, was inconclusive.

The global increase in the proportion of older people and length of life means providing end of life care is now increasingly the responsibility of generalist as well as specialist palliative care providers. But many clinicians find communicating about end of life issues challenging: how do you best discuss imminent mortality, limited treatment options, what to expect when you’re dying, or a patient’s preferences for end of life care?

When this communication is done poorly, or not done at all, patients are confused and less satisfied with their care, experience inadequate symptom relief, and have worse quality of life. Staff who feel insufficiently trained in communication skills are more likely to provide depersonalised care and suffer from burnout.

While research in clinical communication has grown in recent years, there is little consensus on optimal training strategies and the most effective teaching methods. Continue reading

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Multimorbidity could cause a healthcare crisis – here’s what we can do about it

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Older patients often suffer from multiple conditions.
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Professor Chris Salisbury, Primary Health Care, University of Bristol

Multimorbidity is one of the biggest challenges facing healthcare. In recent years, a succession of research studies have shown that people with multiple health problems are more likely to have a worse quality of life, worse mental health and reduced life expectancy. The more health problems someone has, the more drugs they are likely to be prescribed and the more frequently they are likely to consult a GP or be admitted to hospital.

You might think this is all rather self-evident – it’s hardly a surprise that sick people get ill, take medicines and go to doctors more often than healthy people.

So why has multimorbidity become so prominent in discussions about healthcare over the last decade?

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