‘Talking the Talk’: Advancing End-of-Life Conversations

Identifying patients in need of hospice earlier in the course of their illness is a business and moral imperative for hospice providers. Though conversations about end of life are difficult for everyone involved, including clinicians and social workers who facilitate them, they reap substantial benefits for patients, families, payers, and providers.

Early conversations are positively associated with family decisions to limit or withdraw life-sustaining treatments, fewer in-hospital deaths, fewer unplanned hospital admissions, shorter hospital stays, family satisfaction with end-of-life care, and increased odds of receiving strong opioid pain medications in the last 24 hours of life, according to a study in the March issue of the Journal of the American Medical Directors Association. 

“All qualitative research exploring patients’ and family caregivers’ perspectives highlights that it’s up to health care professionals to start these conversations,” Silvia Gonella, R.N., MSc, co-author of the study, told Hospice News. “Unfortunately, this often does not happen, for different reasons—lack of time, difficult topic that staff prefers to avoid.”