Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1997 Dec;12(12):736-41.
doi: 10.1046/j.1525-1497.1997.07158.x.

Barriers to communication about end-of-life care in AIDS patients

J R Curtis  1 , D L Patrick
Affiliations

Barriers to communication about end-of-life care in AIDS patients

J R Curtis et al. J Gen Intern Med. 1997 Dec.

Abstract

Objective: Patients and physicians do not adequately discuss patients' preferences for medical care at the end of life. Our objective was to perform a qualitative study using focus groups to identify barriers and facilitators to communication about end-of-life medical care for patients with AIDS and their physicians.

Participants: Patients with AIDS and physicians with moderate or extensive HIV experience were recruited from clinics and community-based settings using network sampling. A total of 47 patients participated in six focus groups and 19 physicians participated in three groups.

Measurements and main results: Patients or physicians identified 29 barriers and facilitators to communication about end-of-life care. Many patients and physicians expressed discomfort talking about death and dying, and some felt that discussing end-of-life care could cause harm or even hasten death. Several patients expressed the view that a living will obviated the need for discussion with their physician. Previous experience of discrimination from the health care system was a strong barrier to end-of-life communication for some patients with AIDS. Some patients hesitate to bring up end-of-life issues because they want to protect their physicians from uncomfortable discussions. Many patients identified the quality of communication as an important facilitator to these difficult discussions.

Conclusions: Improving the quality of patient-physician communication about end-of-life care will require that physicians identify and overcome the barriers to this communication. To improve the quality of medical care at the end of life, we must address the quality of communication about end-of-life care.

PubMed Disclaimer

Comment in

References

    1. McCue JD. The naturalness of dying. JAMA. 1995;273:1039–43. - PubMed
    1. Uhlmann RF, Pearlman RA, Cain KC. Physicians' and spouses' predictions of elderly patients' resuscitation preferences. J Gerontol. 1988;43:M115–21. - PubMed
    1. Reilly BM, Magnussen R, Ross R, Ash J, Papa L, Wagner M. Can we talk? Inpatient discussions about advance directives in a community hospital: attending physicians' attitudes, their inpatients' wishes, and reported experience. Arch Intern Med. 1994;154:2999–3008. - PubMed
    1. Teno J, Fleishman J, Borck DW, Mor V. The use of formal prior directives among patients with HIV-related diseases. J Gen Intern Med. 1990;5:490–4. - PubMed
    1. The SUPPORT Principal Investigators A controlled trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) JAMA. 1996;274:1591–8. - PubMed

Publication types