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Health Commun. 2018 Nov 26:1-10. doi: 10.1080/10410236.2018.1548335. [Epub ahead of print]

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis.

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a Department of General Practice , School of Medicine, Western Sydney University.
b Concord Hospital.
c School of Public Health and Community Medicine , The University of New South Wales.
d Intensive Care Unit , Liverpool Hospital.
e The Simpson Centre for Health Services Research, South Western Sydney Clinical School , The University of New South Wales.
f Centre for Research in Evidence Based Practice , Faculty of Health Sciences and Medicine Bond University.


Initiating end-of-life (EoL) discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at EoL. We surveyed healthcare practitioners to elicit their exposure to and confidence in EoL discussions and to better understand factors that enable or challenge the initiation of discussions in Australian healthcare settings. Thematic analysis identified that EoL discussions could be emotionally burdensome for healthcare practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between healthcare practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role play and mentoring particularly for younger nurses and doctors were identified. Specific training in EoL communications should target undergraduates and new healthcare practitioners.

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