Background: Older patients often experience sub-standard communication in the palliative phase of illness. Due to
the importance of good communication in patient-centred end-of-life care, it is essential to understand the factors
which influence older patients’ communication with physicians. This study examines older patients’ attitudes
towards, and experiences of, patient-physician end-of-life (EoL) communication in three European countries.
Methods: A secondary analysis of interviews from British, Dutch and Belgian patients over the age of 60 with a
progressive terminal illness was conducted. Cross-cutting themes were identified using a thematic approach.
Results: Themes from 30 interviews (Male n = 20, Median age 78.5) included: confidence and trust; disclosure and
awareness; and participation in decision-making. Confidence and trust were reinforced by physicians’ availability,
time and genuine attention and hindered by misdiagnoses and poor communication style. Most participants
preferred full disclosure, though some remained deliberately ill-informed to avoid distress. Patients expressed a
variety of preferences for and experiences of involvement in medical EoL decision-making and a few complained
that information was only provided about the physician's preferred treatment.
Conclusions: A variety of experiences and attitudes regarding disclosure and participation in decision-making were
reported from each country, suggesting that communication preferences are highly individual. It is important that
physicians are sensitive to this diversity and avoid stereotyping. In regard to communication style, physicians are
advised to provide clear explanations, avoid jargon, and continually check understanding. Both the ‘informed’ and
the ‘shared’ patient-physician decision-making models assume patients make rational choices based on a clear
understanding of treatment options. This idealized situation was often not reflected in patients’ experiences.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)