Dying as a diagnosis: difficulties of communication and management in elderly patients.

91 responses to a standard interview from medical and nursing staff who had cared for 24 elderly patients who died were assessed to determine whether staff and patients knew that dying was part of the diagnosis. 45% of respondents had concluded that their patients knew the clinical diagnosis and 42% that their patients knew death was imminent. Only 18% of respondents had discussed the diagnosis with patients and only 14% had discussed impending death. Other means of communication contributed to the staff's awareness of the patient's knowledge of diagnosis in a further 27% and of impending death in 29%. The needs of 13 of 14 alert dying patients were not adequately appreciated by the staff. Failure of medical and nursing staff to pool perceptions of patients' difficulties may contribute to the inappropriate care of patients dying in hospital and the stress experienced by staff after patients die.