University of Queensland Associate Professor of Sociology Alex Broom is working to help doctors approach such difficult conversations.
“The art of communicating with patients about the end of life is learned ‘on the job’, but doctors are largely unaware of how their colleagues approach these conversations,” he said.
“Some doctors believe it is their role to ensure patients understand and accept their terminal condition, whilst others avoid direct communication about death and dying altogether.
“Talking to patients about the need to move to palliative care is fraught with interpersonal and emotional challenges.
“We expect doctors to be objective and for medicine to be abstract, but doctors are human and are influenced by emotions.
“We don’t often acknowledge that side of medical work.”
Professor Broom and his team, in collaboration with staff at St Vincent’s Brisbane and Mater Health Services, interviewed 20 Brisbane-based medical specialists about how they discuss stopping life-prolonging treatment with their patients, and how they feel about having these conversations.
“The doctors who took part in our study found talking to young patients, and those with very young children, particularly emotionally challenging, and felt a moral imperative to try anything and everything in terms of treatments,” Professor Broom said.
“They talked about wanting to hold on to patients and about how they dreaded, and often delayed, having ‘that conversation’ with them.
“A key reason for delay was that many doctors are more emotionally comfortable as disease-beaters than as bearers of bad news.
“The desire of doctors and their patients to maintain hope may sometimes cause harsh life-prolonging treatments to be pursued, when best practice would be to focus on comfort and quality of life.
“This is particularly crucial given that recent evidence shows that earlier referral to palliative care can extend life expectancy for some patients.”
Results of the study are published in the journal Social Science and Medicine.
The interviews were the first phase of the Australian Research Council-funded project, ‘Pathways to and through palliative care: A sociological study of patient, carer and clinician experiences at the end-of-life’.
Results from this project will be used to better prepare doctors for difficult conversations toward the end of life.