Lääkärit puhuvat kuolemasta

Authors

• Marjanna Artkoski Tampereen yliopisto
• Marja-Leena Hyvärinen Itä-Suomen yliopisto

Keywords:

breaking bad news, communication, death, doctor, education, patient, relative

Abstract

Doctors talking about death

As a philosophical question, death has been a captivating theme from primeval times. Nevertheless, man has a natural capacity to shut out undesirable and elusive matters. Death has nowadays been confined to hospitals and other institutions, thereby making it easy to forget. However, death is always present in the medical doctor’s profession. To discuss impending death with both patients and their relatives is part of a doctor’s duty. With some patients, such as those with cancer, the doctor-patient relationship can become an enduring one, during which the doctor has to encounter both strong emotional reactions and fear of death. Research into this area is scarce; especially in Finland, doctors’ subjective experiences of this theme have hardly been explored. We investigate what kind of an experience talking about death is to doctors themselves and how they discuss this theme with patients and their relatives.

In this qualitative research, the 27 doctors interviewed narrated their subjective experiences of and insights into speaking of death. These doctors represent different sectors of health care as well as eight subspecialties. The results may prove especially useful in doctors’ communication training and generally in the area of health care to develop practical procedures related to speaking about death. The results demonstrate that doctors prefer a fact-oriented working style and a frank manner of discussing oncoming death with patients and their relatives. Most often, these conversations happen during the final phase of the patient’s illness, in which situation the doctor aims at clarifying the situation and soothing the addressees. Doctors seek to keep the flame of hope alive in their patients and direct their thoughts to positive facts such as the continued availability of palliative care and the possibility of living a fulfilling life despite their present condition.

It is typical that, after the doctor has broken the news, patients and relatives raise questions about the prognosis, the effectiveness of treatment and the probability of death, queries to which the medical expert is expected to respond. In this situation, the most important tasks for the doctor are to hold on to the truth, speak with patients and their relatives, and handle their emotional reactions. However, talking about death is a difficult job for the doctor. Some doctors consider talking about death so difficult and emotionally burdensome that they avoid it, delegating the task to a nurse or another specialist. Therefore, doctors should be trained to speak about death early enough to patients and their beloved ones, who function as the central link between patients and doctors.