Patients aren’t having enough serious illness conversations.

• 61% of Californians 65+ want to discuss end-of-life care with their doctor, but only 13% have.¹
• In a 2010 survey of patients with CKD, 83.4% of patients didn’t understand what palliative care was and <10% had discussed end-of-life care with their physician in the last year.²
• In a 2017 survey of 1212 bereaved family members, 1 in 8 believed care in the last month of life was inconsistent with patient wishes. Inconsistent care was associated with worse clinician communication and quality of care.³
• In a 2002 survey of 1185 patients, only 41% of those who preferred comfort care reported that care was consistent with their preferences. Patients receiving care inconsistent with their preferences had significantly higher medical costs.⁴

Many physicians don’t receive adequate training in serious illness conversations.

• 99% of surveyed physicians believe that end-of-life conversations are important.⁵
• 75% believe they are responsible for initiating end-of-life conversations.⁵
• Only 29% report that they have formal training in end-of-life conversations.⁵

Communication skills training improves physicians’ likelihood and ability to have serious illness conversations.

• Communication skills training leads to more, earlier, and more comprehensive serious illness conversations.⁶
• Communication skills training has been shown to significantly improve physicians’:
  • Likelihood to discuss and document goals of care and advance directives^6,7
  • Ability to discuss transition to palliative care^8,9
  • Ability to deliver bad news^9,10
  • Global communication skills^8,10
  • Empathic expression^{11,12,13,14,15}
  • Response to patient emotional cues^{9,10,11,12,13,15,16}
  • Checks for patient understanding^12,13,14
  • Patient-rated trust, perceived empathy, and communication^7,15,17
  • Likelihood to fully meet informational and emotional needs of patients’ family members¹⁸
  • Burnout (emotional exhaustion, depersonalization, and sense of achievement)¹⁷
  • Self-efficacy in performing and teaching serious illness conversations^13,17,19,20
• The positive impact of communication skills training can endure at least 15 months.²¹

Serious illness conversations improve goal-concordance and care experience.

• Serious illness conversations are associated with:
  • Higher likelihood of goal-concordant care^7,22,23
  • Higher patient-rated care experience^7,22
  • Lower likelihood of aggressive care^24,25
  • Increased likelihood and length of hospice stay^24,25,26
  • Lower rates of depression and anxiety in bereaved families^22,24

Serious illness communication interventions can improve patient quality of life and outcomes.

• Serious illness communication interventions are associated with:
  • Higher patient-rated quality of life^{27, 28,29}
  • Longer survival²⁷
  • Fewer depressive symptoms^27,28,29
  • Improved spiritual wellbeing²⁹
  • Lower health costs²⁶

Differences among those with training and formal assessment systems are substantial.

Physicians who have had specific training on end-of-life conversations and those who report a formal system in place for assessing patients’ goals and wishes are different from their peers in some key ways.

For example, physicians who have had training in end-of-life conversations are more likely than those who have not to:

• Say it is extremely important for health care providers to have these conversations with their patients (59 percent vs. 47 percent);⁵
• Talk to patients 65 and older about issues related to advance care planning/end-of-life care once a week or more (79 percent vs. 69 percent);⁵
• Find conversations about end-of-life care to be rewarding (46 percent vs. 30 percent); and⁵
• Say they rarely or not too often feel unsure about what to say when having conversations about end-of-life care (60 percent vs. 52 percent).⁵

Compiled by Dana Farber Cancer Institute in association with VitalTalk.

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