Why does communication matter at end of life? Good communication is at the heart of end-of-life care. The Ombudsman report “A Good Death” into the complaints received to their office about end-of-life care notes that “poor communication is a feature of almost every complaint sent to the Ombudsman.” 7 It also notes the reasons for this poor communication including insensitive tones, rushed messages, misunderstanding about what was said and what was heard and the medical terminology used. The HSE National Healthcare Charter 8 pledges: “We will involve you and your family and carers in decision making about your healthcare and will take account of your preferences and values.” Aligned to this, the Quality Standards for End-of-Life Care in Hospitals 9 state that there should be “timely, clear and sensitive communication with each person, as appropriate, in respect of a diagnosis that s/he may be approaching or at end of life.” Internationally, a meta-analysis of 13 systematic reviews on the conditions for a good death (Zaman et. al, 2021) 10 , found that the second most commonly cited condition for a death to be considered as good was “effective communication and relationship with health-care providers.” Similar to the findings in the National End of Life Survey, other research evidence also shows that whilst the majority of older adults would like the opportunity to discuss end-of-life care with a healthcare professional, only a minority are provided with the opportunity to have these conversations 11 . All older people living with a life limiting condition, including dementia, must be told of their illness and offered the opportunity to be involved in their end-of-life decision making and care. It is integral that a person who may have dementia is given a comprehensive diagnosis and tailored information, as set out in the Model of Care for Dementia in Ireland 12 . Advance care planning is another important aspect of communication at end of life. It can provide people with the opportunity to express their preferences at end of life and allows for these discussions to take place when care decisions are not imminent, or a crisis is occurring.
7 A Good Death , Office of the Ombudsman , 2014 8 National Healthcare Charter , HSE, 2012 9 Quality Standards for End-of-Life Care in Hospitals , Irish Hospice Foundation, 2010 10 What would it take to die well? A systematic review of systematic reviews on the conditions for a good death , Zaman et al., Lancet Healthy Longevity, 2021 11 Do the elderly have a voice? Advance care planning discussions with frail and older individuals: a systematic literature review and narrative synthesis , Sharp et al., British Journal of General Practice, 2013 12 Model of Care for Dementia in Ireland , National Dementia Services, HSE, 2023.
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Telling It Like It Is
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