Communicating with dying patients within the spectrum of medical care fromterminal diagnosis to death

Background: Efforts to improve communication between physicians and dying p atients have been unsuccessful, and guidelines for improving patient-physic ian communication about end-of-life care are based primarily on expert opin ion. This study assessed which aspects of communication between patients an d physicians are important in end-of-life care. Methods: Twenty focus groups were held with 137 individuals, including pati ents with chronic and terminal illnesses, family members, health care profe ssionals from hospice or acute care settings, and physicians with expertise in end-of-life care. Focus group analyses determined domains of physician skill at end-of-life care. Communication with patients was identified as on e of the most important domains. Analyses of components important in commun icating with dying patients and their families were performed. Results: The following 6 areas were of central importance in communicating with dying patients: talking with patients in an honest and straightforward way, being willing to talk about dying, giving bad news in a sensitive way , listening to patients, encouraging questions from patients, and being sen sitive to when patients are ready to talk about death. Within these compone nts, subthemes emerged that provide guidelines for physicians and educators . Dying patients also identified the need to achieve a balance between bein g honest and straightforward and not discouraging hope. Conclusions: Several areas emerged for physicians to focus their attention on when communicating with dying patients. These findings provide guidance in how to improve this communication. They also highlight the need to appro ach communication about end-of-life care as a spectrum that requires attent ion from the time of a terminal diagnosis through death.