What are the most important discussions to have among doctors, patients and families?

It seems obvious to just ask but there is a gap between what patients would like and the care they actually receive, according to a paper in the Canadian Medical Association Journal.

Current guidelines list 11 key elements for health care providers to discuss regarding end-of-life care, although these are based mainly on expert opinion and not on patient and family feedback.

A team of researchers with backgrounds in general internal medicine, critical care medicine and palliative care surveyed 233 older adults in hospital with serious illnesses and 205 family members about the importance of the 11 guideline-recommended elements of end-of-life care. The patients had been admitted to 9 hospitals in British Columbia, Alberta, Ontario and Quebec.

Top 5 things to discuss in end-of-life care, according to patients and families:

• preferences of care in event of life-threatening illness

• patient values
• prognosis of illness
• fears or concerns
• additional questions regarding care.

"However, we found that these elements are infrequently discussed and that concordance between preferred and prescribed goals of care is low," state the authors.

Patients reported that of the 11 key elements, an average of only 1.4 had been discussed with the health care team within the first few days after admission to hospital. The more elements of care that physicians discussed with patients, the higher the satisfaction patients and their families reported about care received.

"Our results suggest that concordance between preferences and prescribed goals of care, as well as satisfaction with end-of-life communication, increase with the number of elements discussed," write the authors.

They hope that their findings will help improve end-of-life care for patients in hospital.

The authors have previously published a related guide in CMAJ called "Just Ask" to help physicians initiate end-of-life discussions with patients and their families.