Who wants to talk about it? The future delivery of end-of-life care
Death and dying remain one of the last taboos in our society. Most people would imagine that their GP would be able to talk to them about the care they want at the end of their lives. But in fact more than two-thirds of GPs have not discussed preferences for their own end-of-life care with their doctor, family or friends – giving reasons such as 'death feels like a long way off' or that they 'have just never thought about it'.
Of those questioned in a survey by The King's Fund, 63 per cent of GPs believe that their personal attitudes towards death will inevitably affect the advice they give patients about end-of-life treatment, with almost half admitting they would welcome some support to improve their ability to talk to patients about death and dying.
These results are unexpected – especially as 76 per cent of GPs saw end-of-life care as an integral part of their job – and patients might find it surprising to learn that even their doctors are reluctant to talk about these issues.
Our research on end-of-life care has shown that avoiding such conversations with patients may impact on whether GPs refer patients to other services in the community, services that would support them and their carers in their homes and avoid unnecessary hospital admissions. Our research also shows it's important that GPs and other health care providers feel comfortable and confident talking to patients about such preferences to ensure high-quality care.
This week we are hosting a national summit to open up discussion on the subject. We're looking forward to meeting with a range of influential stakeholders, communicating openly about some of these challenges and working together to overcome them.
If health professionals are reluctant to communicate about their own end-of-life care preferences – not just those of their patients – then enabling them to have clear and informed discussions on death and dying will be a major step on the road to improving end-of-life care in England.
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Comments
Yes, I'd like to talk about it! When/where is the national summit?
Thanks for your comments Allan! And I'm encouraged by your enthusiasm. We held the national summit last week with a very small group of invited policy-makers, clinicians, service managers and academics. The discussion was extremely fruitful and productive, and we were able to identify 10 critical actions for taking forward the implementation of the End of Life Care Strategy. The report of the summit, and the 10 critical actions, will be published in December 2009 and available on The King's Fund website.
I'm not reluctant, its just something that has not come up, and that is the problem GPs have with patients. When is the right time? Just after diagnosis of a cancer when the experts are saying it will be cured? Before people fall ill? (and then how does a GP get to see people at that time?) At a certain age? "Thank you for popping in.."
Oh how I wish we had some primary care based research in this area than limited headline grabbing stuff from people in ivory towers who have limited experience and understanding of general practice.
Thanks very much for your comments, James. It's really useful to get your views on this topic, and an insight into some of the questions that GPs are facing. These are clearly very difficult conversations to have, and there are a range of reasons why they are difficult.
I agree with you completely that more research is needed in this area, which can provide information and support to all health care professionals, including GPs in the coordination and delivery of end of life care. I'm pleased that a dialogue is starting, which is raising some of the common concerns and challenges in this area.
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