The perspectives of patients, relatives, and healthcare providers on end-of-life communication in an Italian Oncological Institute

We aimed to investigate healthcare professionals’ disclosure of information on EoL, considering the perspectives of professionals and patients and relatives, and the professional factors that may affect communication. Design: The descriptive, mono-centric study E.L.D.Y.-CA.RE. (End of Life Decisions study – CAregivers RElatives) was conducted in 2018 at the Veneto Institute of Oncology in Padua, Italy. Three different questionnaires were created for professionals, patients, and caregivers to investigate EoL decisions, opinions, psychological reactions, and quality of communication. Descriptive analysis and logistic regression were carried out, in order to corroborate the data. A total of 425 questionnaires were completed by 136 healthcare professionals, 171 patients, and 118 relatives. Some subjects were frequently discussed: diagnosis and purpose of medical treatment (89%) or possible complications (92%); less frequently discussed subjects were life expectancy (22%), existential and spiritual dimensions (11%), withholding/withdrawing life-sustaining treatment (11%), and the option of hastening death (3%). Discrepancies emerged especially regarding palliative options, care delivery problems, emotional/psychological, and social problems. Up to 55% of patients did not answer questions because they believed they were not relevant to their health and a consistent proportion of professionals still felt inadequate in communicating bad news and in confronting with terminally ill patients. As emerged from logistic regression models, role, gender, age, and previous training of healthcare professionals, as well as strength of their own and the patients’ beliefs, significantly influenced the subjects discussed.