Royal College of Physicians: Talking about dying. How to begin honest conversations about what lies ahead (October 2018)

Summary

The Talking about dying report seeks to offer advice and support for any doctor on holding conversations with patients much earlier after the diagnosis of a progressive or terminal condition, including frailty.

The report identified that the timely, honest conversations about their future that patients want are not happening. Yet, these proactive discussions are fundamental to effective clinical management plans, part of being a medical professional and align with the aspirations of the Royal College of Physicians's Future Hospital Commission report.

The Talking about dying report begins to highlight and challenge professional reluctance to engage in conversations with patients about uncertainty, treatment ceilings, resuscitation status and death. It offers some ‘mythbusters’ to get physicians thinking and we offer signposts to tools and educational resources to support physicians and other healthcare professionals.

Content

Key recommendations

• Ask the patient if they would like to have the conversation and how much information they would want.
• All healthcare professionals reviewing patients with chronic conditions, patients with more than one serious medical problem or terminal illness, should initiate shared decision making including advance care planning in line with patient preferences.
• Conversations about the future can and should be initiated at any point. The conversation is a process not a tick-box, and does not have to reach a conclusion at one sitting.
• Be aware of the language you use with patients and those they have identified as being important to them, and try to involve all the relevant people in agreement with the patient.