Assessing challenges in end-of-life conversations with elderly patients with multiple morbidities.

Area of Science:

• Geriatrics
• Palliative Care
• Medical Communication

Background:

• Physicians report discomfort discussing end-of-life (EOL) care with elderly patients who have multiple co-morbidities (MCM).
• Lack of prognostic certainty and communication tools exacerbate challenges in EOL conversations for MCM patients compared to those with a single terminal diagnosis.
• Physicians' experiences highlight a need for better support in facilitating these sensitive discussions.

Purpose of the Study:

• To explore physicians' experiences and challenges in conducting EOL conversations with elderly patients with MCM.
• To identify factors contributing to physicians' discomfort and difficulties in initiating EOL discussions.
• To understand physicians' perspectives on timing and approaches to EOL conversations in MCM cases.

Main Methods:

• Semi-structured focus group interviews were conducted with physicians.
• Discussions explored differences in EOL conversations for patients with MCM versus single terminal diagnoses.
• Key themes investigated included timing and approaches to initiating EOL discussions.

Main Results:

• Physicians find EOL conversations more difficult with MCM patients and families than with those with a clear terminal diagnosis.
• A lack of clear prognostic indicators or prompting events hinders the initiation of EOL discussions for MCM patients.
• Physicians utilize direct, indirect, and collaborative approaches to initiate EOL conversations.

Conclusions:

• Physicians' ability to facilitate EOL conversations with MCM patients can be improved.
• Enhanced prognostic indices and standardized communication scripts are recommended to better prepare physicians.
• These tools may reduce physician discomfort and improve the quality of EOL care discussions.