Informal May be Best Approach to End-of-Life Conversations

Researchers also found that a patient’s loved ones were more confident about acting as surrogate decision-makers when they perceived their communication with intensive care physicians to be of high quality. Teaching doctors to be better communicators may be an important step in improving end-of-life decisions for patients, they concluded. Such training isn’t limited to medical school; White points out that, increasingly, clinicians are encouraged to attend communication workshops that focus on end-of-life decisions.

What’s interesting, he tells HealthLeaders Media, is how valuable informal discussions are.

Healthcare reform will provide incentives for formal advance care planning between physicians and patients, such as the completion of advance directives and living wills. But these findings indicate that informal conversations between patients and their families may be very important for both patient-centered decisions and the family member’s comfort with the tremendous responsibility of being surrogates.

"We found it interesting that informal conversations between [patients and] families appeared to be beneficial even in the setting of acute critical illness, a situation that is rarely addressed in formal advance care planning," he says. Informal advance care planning discussions between patients and families may have salutary effects on both achieving patient-centered care as well as efficient use of scarce medical resources.

"Our results support the recent calls for a paradigm shift in advance care planning toward less formal mechanisms to prepare surrogates for their role," he and his colleagues concluded.