Communicating effectively at the end of life.

A majority of patients and families are interested in discussing end-of-life issues with their physicians. End of life conversations can be difficult and challenging for physicians. Several barriers hamper effective communication between physicians and their patients and families. Physicians have received little training to acquire needed interpersonal skills to address end-of-life issues. This article reviews practical approaches for conducting end-of-life discussions. These general guidelines can be used in situations such as advanced care planning, do not resuscitate orders, artificial hydration, and nutrition, and implementation of palliative/hospice care.