Perspectives of elderly veterans regarding communication with medical providers about end-of-life care


Objective: To explore patients' perspectives concerning communication with medical providers about end-of-life (EOL) care. Design: Cross-sectional survey involving semistructured interviews. Setting: Outpatient primary care clinic of a large, urban Veterans Affairs (VA) Medical Center. Participants: Male and female veterans who were 60 years or older, ambulatory, able to speak and read English, residing in the community, receiving outpatient care from the VA, not acutely ill (i.e., not hospitalized or in obvious distress), and not cognitively impaired. Methods: During audiotaped interviews to assess understanding of advance directive concepts, all 30 participants were asked what advice they would give medical students or trainees about how to discuss EOL care with patients. The audiotapes of their open-ended responses were transcribed, coded, and examined using qualitative content analysis, a systematic and replicable technique to uncover meaning by detecting commonalities and regularities of speech. Results: Seven essential elements of advice for medical providers emerged: engage in strategies to ensure patient understanding (mentioned by 30% of participants), communicate honestly and truthfully (27%), develop a compassionate bedside manner (27%), treat others as you would want to be treated (20%), provide empathie care (20%), take the time needed to communicate (20%), and determine patient information and decision-making preferences (17%). Conclusions: Effective EOL discussions with patients require attention to the content, process, and perception of patient-provider communication. © Mary Ann Liebert, Inc.

Publication Title

Journal of Palliative Medicine