The perspectives of patients, relatives and healthcare providers in end-of-life communication in an Italian Oncological Institute.

Background: Studies have highlighted a perceived lack of information concerning end-of-life (EoL) decisions and discrepancies in communication between physicians and cancer patients, despite the fact that sharing these dimensions remains central to the therapeutic process. Objective: We aimed to investigate healthcare professionals’ disclosure of information on EoL, considering the perspectives of professionals and patients and relatives, and the professional factors that may affect communication. Design: The descriptive, mono-centric study E.L.D.Y.-CA.RE. (End of Life Decisions study – CAregivers RElatives) was conducted in 2018 at the Veneto Institute of Oncology in Padua, Italy. Methods: Three different questionnaires were created for professionals, patients, and caregivers to investigate EoL decisions, opinions, psychological reactions, and quality of communication. Descriptive analysis and logistic regression were carried out, in order to corroborate the data. Results: A total of 425 questionnaires were completed by 136 healthcare professionals, 171 patients, and 118 relatives. Some subjects were frequently discussed: diagnosis and purpose of medical treatment (89%) or possible complications (92%); less frequently discussed subjects were life expectancy (22%), existential and spiritual dimensions (11%), withholding/withdrawing life-sustaining treatment (11%), and the option of hastening death (3%). Discrepancies emerged especially regarding palliative options, care delivery problems, emotional/psychological, and social problems. Up to 55% of patients did not answer questions because they believed they were not relevant to their health and a consistent proportion of professionals still felt inadequate in communicating bad news and in confronting with terminally ill patients. As emerged from logistic regression models, role, gender, age, and previous training of healthcare professionals, as well as strength of their own and the patients’ beliefs, significantly influenced the subjects discussed. Conclusion: The perceptions of EoL communication in physician–patient and physician–relative relationships reveal ongoing problems in terms of sensitive and psychological issues, which are often experienced differently. At the same time, the management of terminally ill patients has an emotional impact on medical professionals and affects how they view death. Increased attention to palliative care and training in both communication and bioethics may help to improve professional communication skills and make healthcare professionals better prepared to manage the final stages of a patient’s life and personal reactions to death.