Approaches with more than one target group may be most effective in removing barriers to end-of-life communication

Walczak A, Butow P, Bu S, Clayton J.  A systematic review of evidence for end-of-life communication interventions: Who do they target, how are they structured and do they work? Patient Education and Counseling. 2016 January:99(1):3-16.

Review question

What interventions exist to improve end-of-life communications and how effective are they? What outcomes and measures are used to assess effectiveness?

Background

Communication regarding end-of-life care and decision-making is often challenging for healthcare professionals, caregivers and patients.

End-of-life communication often occurs during acute hospital admissions when patients are near death and may be too sick to participate in decisions about their end-of-life care. Additionally, insufficient information may heighten patient anxiety and raise patients’ suspicions that doctors are withholding information.

Despite the importance of end-of-life communication, no syntheses have been conducted to determine the best approach.

How the review was done

A detailed search of a number of electronic databases for studies published from 1950 to 2014 was conducted. Studies that focused on end-of-life or were designed/relevant for a population for whom end-of-life topics were pertinent, changing an aspect of communication (i.e., utilizing a mode of action such as information provision/education), and communication-related outcomes were included in the review.

A total of 4,627 studies were identified in searches, and 45 were included in the review after assessments for eligibility.

This review was funded by the National Health and Medical Research Council of Australia

What the researchers found

Current interventions target professionals, caregivers and patients (and sometimes a number of these groups). Interventions included role-playing, education and web-based education, and advanced care planning discussions.

The review found that the impact of interventions on outcomes such as patient satisfaction with care, patient understanding of medical information, and changes in end-of-life practices were unclear, although approaches with more than one target group may be more effective at removing barriers to communication.

More attention should be paid to developing validated measures of communication and associated quality of care.

Conclusion

Existing approaches to end-of-life communication target various stakeholders (e.g., professionals, patients and caregivers). There is little robust, clear evidence to show that these interventions change patient outcomes. It appears that interventions with more than one target audience could be more effective in removing barriers to effective end-of-life communication.