Introduction Improving end-of-life care is a national priority. Unsatisfactory care persists in acute hospitals, where there is a lack of communication and advance care planning. Although other reviews focus on the patient’s perspective or different settings, this is the first systematic review that explores why doctors and nurses in acute hospitals avoid initiating end-of-life conversations with patients.
Method Six electronic databases were searched for evidence published between 2008 and March 2015. Studies were included if they reported on barriers to discussing end-of-life with families or patients, as described by doctors or nurses in acute hospitals, excluding critical care. Study quality was assessed using recognised tools.
Results 12 studies were included in the review. Although there is limited high-quality evidence available, several recurrent barriers were identified: a lack of education and training; uncertain prognosis; cultural differences and institutional restraints such as time and resource; insufficient communication and coherence between healthcare teams; and perceived reluctance of the patient or family.
Conclusions The reviewers recommend a board-level commitment in acute trusts to implement policies and protocols concerning appropriate initiation of end-of-life communication; the integration of the multi-disciplinary team across specialities, particularly empowering nursing staff, and communication training which addresses:
Individual issues: practitioner personal beliefs and managing emotions.
Team issues: shared decision-making and patient-centred communication.
Practical tools to enable effective communication.
Organisational issues: creating a culture which facilitates communication about end of life care issues.
Further work Health Education Yorkshire and Humber are using the findings to inform commissioning of communication skills training. Further research will be undertaken to understand the barriers to advance care planning within haematology services.
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