Talking about dying: How to begin honest conversations about what lies ahead

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.

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.

During our research, we 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 RCP’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. We offer some ‘mythbusters’ to get physicians thinking and we offer signposts to tools and educational resources to support physicians and other healthcare professionals.

Getting care right at the end of life is a fundamental and important part of our work as physicians, a key component of the RCP's Our Future Health campaign and a skill set that will be increasingly relevant in our ageing population.

Who's involved

Organisations

A stakeholder round table was attended by:

  • Association for Palliative Medicine of Great Britain and Ireland
  • Faculty of Intensive Care Medicine
  • Breast Cancer Care
  • Macmillan Cancer Support
  • Second Conversation Project
  • Royal College of Nursing
  • St Christopher’s Hospice
  • RCP Committee on Ethical Issues in Medicine
  • RCP New Consultants Committee
  • NHS England
  • Point of Care Foundation
  • Alzheimer’s Society.

The discussions from this round table were continued with attendees after the event, and supported by further communications with:

  • British Geriatrics Society
  • Royal College of Surgeons
  • British Lung Foundation
  • Hospice UK.