Talking about end-of-life care in a timely manner

Abstract

In 2014, a group of physicians of the Catharina Hospital in Eindhoven (The Netherlands) started a project called “Talking about end-of-life care in a timely manner”. Just like others in the country, the Eindhoven group noticed that regularly, very frail elderly people were admitted to hospital in acute situations without there ever having been conversations about their wishes concerning treatment options at the end of life. The project aimed to prevent unnecessary admissions and treatments for these frail patients by stimulating physicians, patients and informal caregivers to start conversations about end-of-life care together at an earlier stage. The first phase of the project consisted of research: a study of the relevant literature on previous projects on the matter and a small empirical study in the Eindhoven region. This yielded as the most important causes of the delay of these conversations: the factors of timing (when is the right moment?), reserve (because of the potential emotional despair of the patient) and hope (who am I to rob a patient of their hope?).In the second phase of the project, several approaches were developed to help caregivers, patients and informal caregivers with the planning and execution of conversations about 
end-of-life care. Meetings were organised for patients and informal caregivers to foster awareness and to provide information. For caregivers, information was provided (via symposia and an app) and specifically designed training sessions were developed. The training sessions consist of reflection on the caregivers’ personal choices with regard to end-of-life care (research has shown that caregivers choose less intensive medical treatments at the end of life) and of practising with the known complicating factors of timing, reserve and hope, and the different ways of thinking and talking about death and dying (typology of death and dying).Educational aimsTo understand the importance of discussing end-of-life care preferences with your patients at the appropriate time.To become aware of the possible interfering factors of timing, reserve and hope in talking about end-of-life care.Key pointsUsing the Surprise Question may be a useful tool in determining the appropriate moment to discuss this with your patients.By talking with your patients about end-of-life care in a timely manner, unnecessary and unwanted treatment can be prevented.Constraints of doctors to implement this in their practice can be overcome by implementing a training session as described in this article.Collaboration between primary and secondary care on this issue is strongly recommended in order to assure the care continuum maximally.