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Mechanisms of end-of-life communication contributing to optimal care at the end of life: a review of reviews
  1. Sahar Khonsari1,
  2. Bridget Johnston1,2,
  3. Hannah Patterson2 and
  4. Catriona Mayland3
  1. 1University of Glasgow, Glasgow, UK
  2. 2NHS Greater Glasgow and Clyde, Glasgow, UK
  3. 3University of Sheffield, Sheffield, UK
  1. Correspondence to Professor Bridget Johnston, University of Glasgow, Glasgow, UK; Bridget.Johnston{at}


Background End-of-life communication is an essential component of high-quality care, but its potential mechanisms for improving care are not well understood.

Objectives To summarise the potential mechanisms by which end-of-life communication may contribute to enhanced end-of-life care in any setting.

Design An overview of systematic reviews, with a narrative synthesis of results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was assessed using the AMSTAR (A MeaSurement Tool to Assess Reviews) tool.

Data sources CINAHL, MEDLINE, Cochrane, SSCI and PsycINFO databases, were searched from inception to January 2024. Manual searches were also conducted.

Eligibility criteria for selecting studies Systematic reviews (published in English) related to end-of-life communication, where the target population was adult patients in their last year of life, relatives, caregivers and/or healthcare professionals involved in communicating with dying patients.

Results We reviewed 35 eligible studies. The reviews suggest potential mechanisms of effective end-of-life communication including collaborative decision-making, tailoring communication to individuals, using effective communication strategies and incorporating communication skills into practice. The reviews also highlighted barriers related to patients, professionals and organisations.

Conclusion This review highlights a nuanced understanding of potential mechanisms of end-of-life communication, emphasising the need for tailored training, policy enhancements and interprofessional collaboration. It calls on healthcare professionals to reflect on their practices, advocating for co-designing a person-centred communication model that addresses patient preferences at the end of life. Importantly, in culturally diverse contexts, there is a need for a communication paradigm that embraces diversity to provide truly empathetic and effective end-of-life care. This concise roadmap may foster compassionate, dignified and effective end-of-life communication.

Trial registration number Protocol registered with PROSPERO (CRD42022271433, 29 March 2022).

  • Communication
  • Cultural issues
  • Palliative Care
  • Psychological care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • X @BridgetJohnst

  • Contributors BJ was responsible for the overall conception and design of this study. SK helped with design, performed the searches and evaluated studies for inclusion. SK extracted data from selected studies. BJ and SK assessed the quality of selected studies. BJ, CM, SK and HP reviewed the work. BJ and SK drafted the paper. BJ, SK, CM and HP revised the manuscript critically for important intellectual content. BJ, SK, CM and HP approved of the version of the manuscript to be published.

  • Funding This work was partly funded by a Scottish Government grant 2021/2022 and an NHS Greater Glasgow and Clyde endowment grant.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.