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Poor communication is compromising care for the dying

Author: John You, Associate Professor of Medicine, McMaster University
19 April 2018

Research shows that up to 70 per cent of seriously ill, hospitalized elderly Canadians are receiving invasive end-of-life treatments that they don’t want.

This could be your mother or your grandfather. Maybe someday, it will be you.

For more than 10 years, our team of health researchers, Canadian researchers at end-of-life network or CARENET, has been working to understand and improve palliative and end-of-life care in Canada.

We know that many older patients with serious illness want to maintain quality of life rather than prolong it. However, the use of aggressive life-sustaining technologies in this vulnerable population is common.

Instead of a peaceful end-of-life experience, they are receiving invasive medical treatments during their last days.

Too little, too late

A national, multi-year study involving seriously ill older Canadians revealed that even though 28 per cent of the participants stated a preference for “comfort care” (meaning no curative treatments), this was documented in only four per cent of their charts.

This discrepancy can lead to a poor end-of-life experience and an increase in family distress.

Why is this happening? Often, it comes down to a lack of communication. Even though studies have shown that seriously ill patients and families have identified end-of-life communication and decision-making as high priority targets for quality improvement, these conversations are typically “too little, too late and not great.”

The gap doesn’t just exist within the hospital setting. A 2014 Ipsos Reid survey revealed that 60 per cent of Canadians want their family doctor to talk to them about their preferences for care at the end of life, but only 26 per cent of primary-care physicians are comfortable having those discussions. Sixty-seven per cent of primary-care physicians said they need more resources and information.

These conversations are also rare in long-term care homes, even though death is commonplace in this setting.

It’s clear that we are failing to provide optimal care to older Canadians at the most vulnerable time of their lives. Read more...The Conversation

See more articles in Care

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