End-of-Life Care Becoming a Slippery Slope for Physicians

By Rebekah McCallister

J Am Geriatr Soc

End-of-life care has become a slippery slope for many physicians. Family members and caregivers of dying patients all too often are left feeling out of the loop when it comes to the prognosis of their loved one, according to a recently published study (. 2007;55:846-856).

Communication between physicians and their patients is of the utmost importance to family members of patients receiving end-of-life care, according to the results of this study.

IMWR

"It is important to become comfortable discussing death and dying with long-term care residents and their families," Holly Biola, MD, MPH, Duke University, Durham, NC, told . "Make sure that long-term care residents' family caregivers know your name. Try to meet the primary family caregiver at least once face to face, either at bedside or in your office. Be sure to discuss end-of-life issues with long-term care residents and their family caregiver. When you feel that death is likely in the next few months, say so."

Investigators analyzed responses from 1 family caregiver for each of the 440 deceased residents of nursing homes or residential care/assisted-living facilities.

Variables included demographic and facility characteristics, as well as 7 items rating the Family Perception of Physician?Family Caregiver Communication (FPPFC) at the end of life, each of which was scored on a 4-point scale (0 = strongly disagree, 1 = disagree, 2 = agree, and 3 = strongly agree). The 7 items were:

1. Was the family kept informed?
2. Did the family receive information about what to expect?
3. Did the family understand what the physician was saying?
4. Was there any discussion about wishes for medical treatment?
5. Did the family have the opportunity to ask questions?
6. Did the family feel listened to?
7. Did the family feel understood?

Nearly half of the responders rated poorly their communication with the caring physician:

• 39.9% said they were not kept informed
• 49.8% did not receive information about what to expect
• 43.1% had not understood the physician.

These results indicate that family caregivers reported better FPPFC scores if they had met the physician face-to-face, and if they understood that death was imminent.