Research suggests that communication near the end of life is problematic. A literature review was conducted to identify barriers to optimal communication near the end of life and strategies to overcome them. Barriers include clinician beliefs, patient characteristics, American popular and medical cultures, and the health care system. Clinician and patient barriers can be addressed through education, advance planning, the inclusion of patients' family members, and individualizing care. Cultural and systems problems can be addressed through public as well as professional education, alternative models of care, and coalition building. Combined, these approaches can help improve communication near the end of life and ultimately improve care for the dying.
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