Improving the quality of end-of-life discussions

This article provides an update on the recent research and evidence regarding quality in end-of-life (EOL) discussions with a focus on the care of a person with cancer.

Clinicians have the challenging task of customizing the information exchange that occurs during an EOL discussion. Patients identify important stipulations that accompany a desire for frank EOL discussions. These include timing of the discussion, ensuring evaluation of readiness to engage in the EOL discussion, and being invited to participate. The timing of an EOL discussion is likely to be more important than the setting in which an EOL discussion occurs. Less than 1 month prior to a person's death is likely to be an inadequate amount of time to allow a patient to consider and reflect on his or her EOL preferences. Among those admitted to the hospital, delay in the timing of EOL discussions carries the risk of losing decision-making capacity.

There is greater use of quality metrics as patient outcomes among studies examining EOL discussions. System-wide approaches to improving EOL discussions should include standardized documentation templates that are widely accessible in electronic medical records.