Background Hospital is the most common place of death with 43.4% of all deaths in 2022 (Office for Health Improvement & Disparities. Palliative and end of life care profile December 2023 update: Statistical commentary). It is well understood that early conversations benefit dying patients and their families in helping to deliver high quality end of life care (National Audit of Care at the End of Life. Fourth round of the audit (2022/23) report: England and Wales. NHS Benchmarking Network; 2023). However, in acute settings, end of life conversations are frequently had by non-palliative care clinicians in busy, chaotic settings including emergency departments. We investigated factors that impact the quality of conversations and how clinicians feel about them.

Aims To explore the language, emotional impact and challenges of end of life conversations in an acute setting by clinicians who are not palliative care specialists, with the aim to improve practice.

Methods Clinical staff in an acute NHS Trust were invited to complete an online questionnaire consisting of 14 multiple choice, open and ‘what three words’ questions.

Results 54 responses received, of which 39 were doctors (15 consultants), 15 nurses, allied health professionals and healthcare assistants. The question ‘what three words describe how you feel when talking about death and dying?’ evoked some strong emotions: ‘sad,’ ‘heartbroken’ and ‘fearful’; as well as recognising that these conversations are ‘important’ and ‘necessary’. Other questions revealed challenges clinical staff face, e.g. time pressures (51%), clinical uncertainty (46%), and worries about upsetting patients (59%). The survey found that clinicians use a variety of direct and euphemistic phrases when someone has died. However, consultants tend to use ‘died’ more than the junior doctors (80% vs 50%).

Conclusion The survey demonstrates a wide range of practice. Senior clinicians report using more direct language which is in line with Hospice UK’s finding that bereaved families prefer this (Dying Matters Awareness Week: The power of honest conversations. 2024). The survey also revealed barriers to good communication as well as the emotional impact, illustrating the need for ongoing education, support and role modelling for non-specialist palliative care staff in end of life conversations.