TALKING ABOUT ATTITUDES TOWARDS THE END OF LIFE: WHAT DOES IT NEED?

摘要

To individually plan end-of-life care, open communication about a person′s preferences and attitudes towards death, dying and the finitude of life is required. It can facilitate dignity and quality of life in patients and relatives. To improve the process of communication, structured guided tools might serve as door opener for these conversations. Most tools focus on care preferences without assessing the person′s underlying attitudes in detail. This study aimed at getting insight into specific requirements and conditions for communicating about the end of life in various end-of-life care settings. Four focus groups were conducted with health care professionals and volunteers (N=18) from hospice and palliative care and nursing homes in Germany. Interviews were audio taped and transcribed verbatim. The experiences of these experts, being conversational partner in end-of-life discussions, were analysed by a content analytic approach. Having end-of-life discussions primarily depended on a pleasant atmosphere, trusting bonds between conversational partners and a professional attitude of staff members. Conversations should be implemented into existing care structures, start “early”, include relatives and use low-threshold impulses to start conversations. Each staff member could be conversational partner about attitudes towards the end of life, but some reported insecurities doing so. Further skill training concerning end-of-life discussions is needed, especially in nursing homes where staff has different levels of experience and skills. Care structures need to be adapted to facilitate communication about the end of life in daily care. Furthermore, tools using low-threshold impulses can facilitate communication when conditions of the care setting are considered.