Barriers to communicating well with families: what we heard from clinicians
Clinicians described conversations with families about a loved one approaching the end of life as one of the most challenging aspects of their role. These discussions often happen when families are already highly distressed, shocked or overwhelmed.
Managing family wishes
Clinicians told us that end of life conversations with families can be especially hard when relatives are not ready to openly acknowledge that their loved one is dying. In some instances, families wish to exhaust all treatment options even when the interventions might cause the patient to experience more pain:
‘It can be hard getting the balance right between trying to treat someone in line with family wishes and not causing them suffering. It can bring up difficult situations for the medical and nursing team when we're treating someone when ultimately, we know they are dying, but their family are struggling to come to terms with it and are pushing for treatment, which could be invasive and uncomfortable.’
We heard that family dynamics can surface when their loved one is at the end of life. Family members may have different views about the level of information to share with either the patient or other family members, or about decisions around treatment:
‘End of life can bring up some family dynamics which haven’t been resolved. At times these scenarios will harmonise the family dynamic from before, or it may cause more complexities.’
Cultural values and religious beliefs
Clinicians told us that cultural and religious differences can play a significant role in end of life conversations and decision-making. They explained that people from different cultural backgrounds can have very different expectations of what end of life care should involve and the choices they feel comfortable making. In some cultures, clinicians described a strong drive to ‘do everything possible’, with families finding it particularly hard to accept that someone is approaching the end of life. Clinicians said this requires them to be mindful of cultural values and religious beliefs, and to carefully tailor their communication, drawing on emotional intelligence and sensitivity during these conversations.
Compassionate care under stress
The clinicians we spoke to are highly motivated to provide compassionate care, but they acknowledged that the reality of working on busy wards can make this challenging at times. They described managing patients with very different needs, often across many specialties at once, while dealing with staff shortages, time pressures and keeping detailed records. When resources are stretched, it can be harder to show the level of empathetic care they want to:
‘There are a lot of variables impacting being able to be empathetic all the time… I’m not excusing why someone should be rude anytime, but there has to be a reminder that we still have to deliver, no matter what.’