The meaning of everything: communication at the end of life

Abstract

Communication about end-of-life care is increasingly recognized as a core clinical skill, but doctors are often unprepared to have these conversations. Crisis situations at the end of life, such as when a hospitalized patient with a poor prognosis requests that “everything” be done, pose even greater communicative challenges. Such decisions are often regarded as a demand for care that may be burdensome or even harmful, rather than the start of an important conversation about values and goals. Situations such as this have prompted the development of prescriptive approaches to communicating with patients, which have limitations since they focus more on the physicians’ message than on developing a relationship with the patient or eliciting the meaning of the illness and its treatment. Current models of communication are less about accurate transmission of information and more about the ways in which communication constitutes our social world. Thus, the goal of communication training for physicians should be less about tools and scripts, and more about doctors learning to engage patients in conversation. We suggest strategies for promoting dialogue to more effectively explore the concerns and misunderstandings that might underlie decisions to “do everything.”