The Royal College of Physicians has published updated guidance for doctors holding conversations with patients who are coming to the end of their life.
Talking about dying 2021: How to begin honest conversations about what lies ahead provides advice and support for doctors on holding conversations with patients soon after the diagnosis of a progressive or terminal condition, including frailty.
The updated guidance includes a set of mythbusters on palliative care and cardiopulmonary resuscitation (CPR), several recommendations for physicians, and a full copy of the original report from 2018 with case studies and references.
The Royal College of Physicians' original 2018 Talking About Dying guidance, was created to support those healthcare professionals who were struggling to broach the subject of death and dying with their patients. Three years later, this is more relevant than ever, with many clinicians having seen more deaths during the pandemic than they ever did before. Those who were redeployed as part of the COVID-19 response may also have had to provide more palliative care than they had training for or were used to in their specialties.
In many cases healthcare professionals will have needed to have these conversations with patients and their families virtually, adding to the complexity of these discussions.
These conversations are of particular importance given the UK’s ageing population and the fact that more people than ever are living longer with multiple health conditions. Nearly half of all deaths in England occur in hospital, yet 29% of patients at the end of their life report not having an individualised care plan.
Andrew Goddard, president of the Royal College of Physicians, said: “Talking about death and dying is a sensitive issue in our culture, and is something that many of us struggle to articulate. What we must bear in mind, however, is the positive impact these discussions can have on dying patients and their families.
“Advance care planning and early introduction of palliative care can improve a patient’s quality of life and mood, reduce aggressive treatments towards the end of life, reduce emergency hospital admissions and in certain groups it can even extend a patient’s life expectancy.
“I hope that this guidance equips clinicians with the skills and confidence to take these conversations forward.”
