Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.


Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Should patients always be made aware they are nearing end of life?

  • Comments (25)

Richards NM et al
(2014) How do patients respond to end-of-life status? Nursing Times; 110: 11, 21-23.


UK palliative care policy and philosophy endorse open awareness, where all parties acknowledge that the patient’s death is approaching. Perceived benefits of making patients aware of their prognosis include being able to plan a variety of activities, so arguably death occurs more in keeping with their wishes.

To explore if and how information about a transition to palliative care was communicated to patients discharged from hospital who fulfilled standardised criteria for palliative care need.

Literature review
Despite evidence of a link between encouraging people to talk about dying and an improved dying experience, persistent barriers exist to entering a context of open awareness.

Semi-structured interviews were conducted with 15 patients and three family carers, 3-6 months after discharge from hospital. A thematic analysis was undertaken.

Despite indications that participants might be nearing the end of their lives, most were unaware of their prognosis and showed little insight into what they could expect from the trajectory of their disease.

Patients can be reluctant to gain knowledge that requires them to face the imminence of death. This can create tensions for nurses about how they relate to and communicate with patients facing incurable illnesses.

To ensure timely access to palliative care, new and innovative ways of delivering palliative care are needed, which do not rely on the ideologically based assumption that awareness can and should be encouraged in all cases.

What do you think?

  • This research found that most of the patients they interviewed were unaware of their prognosis, why do you think this is?
  • Should patients always be told that are nearing end of life? Are there some situations when this would not be appropriate?
  • How can a patient’s reluctance to accept that they are dying impact on the care they receive?
  • Comments (25)

Readers' comments (25)

  • Anonymous

    Absolutely .......I don't know why a person shouldn't be aware of their own fate.

    Unsuitable or offensive? Report this comment

  • Anonymous

    strange, we always managed before. why are do some many of these old issues keep coming up? nothing wrong in discussing them, of course, and finding new and better ways of doing some things, but there are others one wonders why they have suddenly become new issues that people seem no longer able to handle!

    Unsuitable or offensive? Report this comment

  • Anonymous

    These issue keep coming up because they are important for those who are dying and for their relatives and clearly we are not dealing with them as well as we could be. Everyone has the right to know their diagnosis and prognosis, however, not all patients can cope with that information. It is the duty of health professionals to identify if the patient is ready to hear this news. This requires good communication skills, compassion and understanding, and acceptance that if the patient is clearly indicating that they do not want to know, then this is a coping mechanism that requires careful management.

    Unsuitable or offensive? Report this comment

  • Anonymous

    It can get very confused if the patient, and the family, don't know the patient is dying.

    Unsuitable or offensive? Report this comment

  • michael stone

    A topic I am up-to-speed on: to save repetition, I’ll use web-links and hope they work !

    I’ll start with:

    The first questions I discussed in there, were ‘'what does terminal mean' and 'do terminal patients, need to be told the detail of their prognoses'.’

    The point I made, was that death affects [continuing after death] wider-life issues, so:

    'End-of-life patients, must be given the opportunity to take heed, even if individual patients choose not to take heed'.

    There are fundamental issues afflicting the ‘discussion of the dying bit’ – see my post on the BMJ website:

    Moving on to the consequences of not telling relatives that their loved ones are dying, under the title ‘Should hospital nurses and doctors be keeping the relatives of patients informed ?’ I posted a piece about that, roughly a week ago, at:

    The post pointed to by the link directly above, points out that it was prompted by an unsolicited contact from a person who had a very upsetting experience when a parent died in hospital, and recently I’ve been in the somewhat weird situation of acting as an intermediary for a reply from Bee Wee, who is leading on the ‘Liverpool Care Pathway Replacement Work’, to that person. Bee sent an e-mail yesterday, and this is extracted from it – it isn’t controversial, as it is clear that this was the position of the Consultation Document:

    ‘When a person’s condition deteriorates or change, they must be reassessed and a judgement made about whether that change is potentially reversible or whether they are likely to die in the next few hours or days from their condition. Decisions about what actions to take, e.g. further tests or treatment, focus on comfort care, etc. are made depending on the clinical assessment of the person, and discussions with the person (if they are able and wish to discuss) and their family. As a clinician, I would always want to review those decisions and discussions so that plans are modified as necessary. These are often not black and white situations, and the level of uncertainty about what’s likely to happen is something that clinicians have to learn to communicate and discuss properly with patients and their families. In my experience, most people can understand and accept that there are uncertainties (even if they find it hard), provided this information is shared and discussed with them. In the Alliance’s description of what good care in the last days to hours of life should look like, communication and involvement in decision making are both important priorities.’

    That bit, was Bee’s reply to a phone call via ‘Bee’s office’ that this upset person had made (the person spoke to someone, who passed details on to Bee: Bee and the person did not speak directly), but I had sent an e-mail to Bee before the phone call, telling Bee that I had given the person a phone number for Bee, and I commented in that e-mail:

    ‘So you might get a phone call to that number – she is really disturbed by what happened to her parent (and as usual, to my mind it stems from the clinicians not properly discussing things like DNACPR and LCP with the family – as her mum was long-term demented, you would think when such a patient is admitted those conversations would definitely happen, but apparently not)’

    Bee also commented on my comment in the e-mail:

    ‘I agree with the point you make, Mike, that it is often the lack of discussion (or perhaps the inadequacy of it) that is often at the heart of what goes wrong in decisions and actions taken.’

    Unsuitable or offensive? Report this comment

  • Anonymous

    michael stone | 11-Mar-2014 1:48 pm

    Monologue alert: these boards are not here for you to endlessly list email, phone calls and other communications you've had.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Anonymous | 11-Mar-2014 8:43 pm

    even persistent self-interested and self-important Trolls?

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 11-Mar-2014 8:43 pm

    Just out of interest, are you the same person who told me 'that your views are irrelevant, because you are not a nurse [and hence don't know what you are talking about]' ? And the person who explained to me that 'I believe my professor, because he knows what he is talking about, unlike you ?'.

    How exactly does my position/views, coinciding with the views of people like Bee Wee, fit into that ?

    Read the argument(s), please - a decent analysis should stand on its own two feet !

    Unsuitable or offensive? Report this comment

  • Anonymous

    michael stone | 12-Mar-2014 11:15 am

    No, I've only addressed your incessant postings quite recently - following an intervention from another poster.

    Everyone has the right to express their views, but you seem to use this board as an extension to your professional interests in that you endlessly list communications you've had with others that are largely irrelevant to anyone other than you.

    Personally, I don't care who you've emailed or telephoned and whether they agree with your position or not. Post your views by all means, but don't feel as though you have to qualify everything with endless lists and links.

    Unsuitable or offensive? Report this comment

  • Anonymous

    Anonymous | 12-Mar-2014 11:58 am

    totally agree with anonymous above. it just appears as name dropping to try and show how important "I" am. Who cares, other than "Mr Me, Me, Me" and who is in the least interested. I used to read and comment with great interest as well as some pleasure here but now get fed up with seeing all these lengthy comments and views from MS on almost every single page, and have all but given up. If you do comment you usually have the right to some vacuous and very self-opinionated response from MS who has no knowledge whatsoever of nursing care or the functioning of the profession, and although lay views and opinions are always welcome those of MS are excessive and bordering on the obsessive and often disruptive to the threads whereas others are interesting and in greater moderation. Michael Stone is only interested in Michael Stone's own personal agenda and own expert opinion.

    So much for NT sales and readership, each to his taste, and he does have his little band of supporters and those he follows like a little shadow, but there are plenty of other quality professional journals out there to read.

    Unsuitable or offensive? Report this comment

View results 10 per page20 per page50 per page

Have your say

You must sign in to make a comment.

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.