Hospitalized patients and their families complain about the quality of end-of-life care, and a review in the Canadian Medical Association Journal offers guidance on talking with patients and their families about their preferences and what to expect.

The review suggests that such conversations about death should be thought of as a process rather than a single event; and if you would not be surprised that the patient died within the next year, it’s best to start that process. In doing so, the authors advise that family members be invited to the conversation.

The physician should be prepared to offer prognostic estimates (the authors provide links to helpful online estimators) while acknowledging uncertainty. As important, learn the patient’s values and record them clearly in the medical record.

The authors offer two seemingly less important, perhaps obvious points for these discussions: first, sit down, and second, make eye contact.

Source: CMAJ