Patterns of Communication About Serious Illness in the Years, Months, and Days before Death.

BACKGROUND

Communication with patients and families about serious illness impacts quality of life and helps facilitate decision-making.

OBJECTIVE

To elucidate the pattern of communication about serious illness for patients who have died in an inpatient setting.

DESIGN

Three hundred patients from the Swedish Registry of Palliative Care 2015-2017 were randomly selected for manual chart review.

SETTING

Patients who died in a palliative care, oncology, or internal medicine unit in Sweden were selected.

MEASUREMENTS

We report on the frequency of conversations at three time points, 6 months or longer before death ("Years"), 15 days-6 months before death ("Months"), and 0-14 days before death ("Days"). We also report the timing of the conversation about dying.

RESULTS

A total of 249 patients were included after exclusions; they had an average of 2.1 conversations (range 1-6). The first conversation took place a median of 53 days before death and the last conversation took place a median of 9 days before death. Separate conversations with the next of kin took place a median of two days before death. We could verify a conversation about dying in only 156/249 (63%) medical records.

CONCLUSIONS

Communication about serious illness between clinicians, patients, and families occurs iteratively over a period before death. Measuring the quality of communication about serious illness using a years, months, and days framework may help ensure that patients and families have sufficient information for medical and personal decision making.