A scoping review of end-of-life communication in international palliative care guidelines for acute care settings.

Abstract Context End-of-life communication in acute care settings can be challenging and many patients and families report dissatisfaction with those conversations. Objective To explore existing guidelines around palliative care to increase current understanding of end-of-life communication processes applicable to the acute care setting. Methods A scoping review following the method of Arksey and O’Malley was undertaken to identify eligible documents and thematically summarise findings. Websites of government authorities, departments and ministries of health as well as palliative care organisations were searched as were MEDLINE, CINAHL (EBSCOhost), EMBASE, Cochrane Library, Joanna Briggs Institute and PsycINFO databases. Searches were limited to documents published between January 2009 and August 2019 that were non-disease specific and applicable to the acute care setting. Results Thirteen guidelines from nine different countries were identified. Thematic analysis produced eight themes: 1) The purpose and process of end-of-life communications, 2) Cognitive understanding and language in end-of-life communication, 3) Legal aspects of end-of-life communication, 4) Conflicts and barriers related to end-of-life care, 5) End-of-life communication related to medical record documentation, 6) Healthcare professionals’ responsibilities and collaboration, 7) Education and training and 8) Policies, guidelines, and tools for end-of-life communication. Conclusions Palliative and end-of-life guidelines applicable to acute care settings outline the purpose of end-of-life communication and address how, when and by whom such conversations are best initiated and facilitated. How guidelines are developed and what aspects of communications are included and emphasised may differ across countries related to role differences of physicians and nurses and national laws and regulations.