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Talking about dying: How to begin honest conversations about what lies ahead

The core mission of the Royal College of Physicians (RCP) is to drive improvements in health and healthcare through advocacy, education and research. Drawing on the diverse experience and expertise of our 35,000 members and fellows, the RCP seeks to support clinicians in addressing the challenges facing our healthcare system today.

This year the RCP began a multimedia campaign, Our Future Health, to shine a spotlight on the daily dilemmas that physicians face on the front line. An area of majorb concern to physicians was uncovered: end of life care. When asked ‘How can we empower doctors, patients and carers to make shared decisions about care and treatment that balance duration and quality of life?’, physicians revealed that starting these conversations with patients and family is challenging and, at times, impossible.

The role of doctors and their relationship with the patients they care for has changed from when the NHS was set up 70 years ago. There are fewer ‘transactional’ consultations about a single, curable illness or injury, and a much greater need for individualised management of symptoms and conditions. For people to live as well as possible despite long-term and terminal illnesses, integrated and wholesystem care is required. We all need to be equipped to offer patients honest conversations about what they can expect in the future, to give them choices and control over the remainder of their lives. This is not just about high-quality palliative care in the last weeks or days, but about holding conversations much earlier after diagnosis of a progressive or terminal condition, including frailty.

This report seeks to offer advice and support for any doctor to meet these challenges when caring for patients with a diagnosis of a serious, potentially life-limiting illness. It highlights some of the barriers, and busts common myths that might hamper a successful conversation between doctor and patient. We have also collated a series of resources and best practice to aid doctors to develop and improve in confidence when discussing their patients’ preferences and values, as they approach the end of life.