Objective: To explore patients' perspectives concerning communication with medical
providers about end-of-life (EOL) care.
Design: Cross-sectional survey involving semistructured interviews.
Setting: Outpatient primary care clinic of a large, urban Veterans Affairs (VA) Medical Center.
Participants: Male and female veterans who were 60 years or older, ambulatory, able to
speak and read English, residing in the community, receiving outpatient care from the VA,
not acutely ill (i.e., not hospitalized or in obvious distress), and not cognitively impaired.
Methods: During audiotaped interviews to assess understanding of advance directive concepts,
all 30 participants were asked what advice they would give medical students or trainees
about how to discuss EOL care with patients. The audiotapes of their open-ended responses
were transcribed, coded, and examined using qualitative content analysis, a systematic and
replicable technique to uncover meaning by detecting commonalities and regularities of
speech.
Results: Seven essential elements of advice for medical providers emerged: engage in strategies
to ensure patient understanding (mentioned by 30% of participants), communicate honestly
and truthfully (27%), develop a compassionate bedside manner (27%), treat others as you
would want to be treated (20%), provide empathic care (20%), take the time needed to communicate
(20%), and determine patient information and decision-making preferences (17%).
Conclusions: Effective EOL discussions with patients require attention to the content, process,
and perception of patient–provider communication.
