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Nurse Educ Today. 2016 Jan;36:395-400. doi: 10.1016/j.nedt.2015.10.015. Epub 2015 Oct 26.

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students.

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King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London SE1 8WA, United Kingdom. Electronic address:
Clinical Communication, King's College London, School of Medicine, London, United Kingdom.
Pre-registration Programs, Sydney Nursing School, The University of Sydney, Sydney, Australia.



Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice.


The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students.


A qualitative study comprising five focus groups.


Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University.


Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input.


In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.


Communication; Dying; End-of-life; Focus groups; Medical students; Nursing students; Qualitative

[Indexed for MEDLINE]

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