Theses Master's

Difficult conversations when treatment becomes end-of-life care: A narrative review of US evidence on the role of medical communication in achieving a patient-centered approach towards end-of-life care

Arusilor, Isabelle-Maria

In our death-averse society, discussions around end-of-life (EOL) decisions and EOL care are not always welcome. Yet, when physicians initiate and appropriately carry out these conversations, they have the potential to significantly alter and improve dying patients’ quality of life (QOL) (Harrison et al., 2022; Parikh et al., 2022; Sutherland, 2019; Rakoski & Volk, 2019). Medical professionals play a crucial role in explaining the goals of medical treatments, identifying care plans with patients and their families, discussing life-sustaining therapy options, educating patients and their families on existing options, making recommendations, and helping them decide what approaches best match their goals in end-of-life care (Manalo, 2013). This narrative review aims to help establish existing knowledge on the topic of EOL conversations and to identify any existing gaps. Evidence suggests that patients with access to goals of care (GOC) discussions and palliative care (PC) experience a greater quality of EOL care than those who do not
(Wachterman et al., 2016; Sutherland, 2019). Yet, research suggests that many patients die in unrelieved pain, without an opportunity to appropriately discuss their EOL preferences (Larson & Tobin, 2000). The quality of medical interventions and EOL care for terminally ill patients is greatly determined by a series of conversations that they have with their providers; yet, medical professionals often report feeling unprepared and uncomfortable bringing up the topic of death with patients and their families (Sutherland, 2019; Larson& Tobin, 2000; Nagpal et al., 2021). Focusing on the United States (US), this narrative review of the literature will address the topic of EOL conversations and their importance for QOL in EOL care, identify relevant professions involved in the process, discuss barriers that they can experience when initiating EOL conversations, as well as existing interventions that can support this practice.


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More About This Work

Academic Units
Sociomedical Sciences
Thesis Advisors
Siegel, Karolynn
M.P.H., Mailman School of Public Health, Columbia University
Published Here
May 2, 2023