Help for doctors

  • Talking Points

Help for doctors

In 2018, the UK professional membership body The Royal College of Physicians (RCP) led a project for doctors on Talking about Dying – How to begin honest conversations about what lies ahead.

In 2021, these and other comments were added– for doctors.

Ageing patients

The UK has an ageing population and more people than ever are living longer with multiple health conditions. One in three adults admitted to hospital as emergencies and 80% of care home residents are in their last year of life. Nearly half of all deaths in England occur in hospital. Yet the National Audit of Care at the End of Life (NACEL) in 2019 reported that 29% of patients at the end of their life did not have an individualised care plan.

It’s hard to talk about dying

Talking about dying is never easy, but it is worthwhile. Advance care planning and early introduction of palliative care can improve the patient’s quality of life and mood, reduce aggressive care at the end of life, reduce emergency hospital admissions and even extend life expectancy of certain groups.

Most people want to know

77% (but not everyone) of people in England and 73.9 % internationally (in a random telephone survey of over 9000 persons) said that they would want to be informed of having a serious illness such as cancer with less than a year to live.

Not every patient will want to talk about death, and those that do not want to should have their wishes respected, but every patient should be given the opportunity to have the discussion.

Strong advice to doctors during the pandemic: The core principles remain the same: be honest, use clear language and avoid euphemisms. With potentially just your voice to go on, the words you choose are crucial. If on the phone it can be harder to know whether the person on the other end has fully understood.

The link below takes you to the 2021 article which also contains a link to the full 2018 original.

https://www.rcplondon.ac.uk/projects/outputs/talking-about-dying-

The Talking about Dying authors and team comment:

But what about Spiritual issues?

It is encouraging that The Royal College of Physicians has recently emphasised the importance of being ready to talk about dying and to have conversations about what is likely to lie ahead. The articles they refer to draw on the valuable experience of key organisations and charities involved in the care of those facing their mortality.

We also need to recognise that those nearing the end of life often feel their deeper needs are not easily shared. Even those without a living faith can seem more spiritually aware. They sense a strong need for forgiveness, reconciliation, and recognition of their life’s achievements. They wish for a sense of not being alone and of not being an unloved burden to those around. Besides the pain of parting, and of practical concerns, many have a sense of hearing God and wondering how to respond, even when they have not committed their lives to any particular faith.

Those seriously committed Christians who have entrusted their lives to Jesus find their needs being met, and prayer to be real. Carers are able to bring compassion and, with God’s enabling, can be alongside the cared for person where they feel weak, vulnerable, lonely or broken. This compassion brings release and leaves a sense that it will be alright to die.

Many years ago, the late Lord Coggan, former Archbishop of Canterbury, said he hoped we would move forward to a day when death will not be regarded as a sordid end. Rather dying well should be seen as an act of dignity worthy of someone made in the image of God. While it ends one phase of personhood, it ushers in a new phase for which they were created. For Christian believers this is the vision of God, sometimes seen dimly on earth, but fulfilled in life eternal".