End-of-Life Conversations: Lessons from Experts
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End-of-life conversations can be some of the most challenging and meaningful interactions in healthcare. Knowing how to navigate these discussions with clarity, compassion, and confidence can make a profound difference for patients and their families.
In this End-of-Life Essentials Communication Masterclass webinar, Project Lead Associate Professor Kim Devery led a panel of palliative care experts who shared their experiences, insights, and strategies for handling these delicate conversations. The panel included:
- Associate Professor David Holden, Specialist in Palliative Medicine, Northern Adelaide Palliative Service, Course Coordinator, University of Adelaide
- Melissa Bruno, Palliative Care Nurse Consultant and Lecturer at Flinders University
- Sara Fleming, Nurse Practitioner and Senior Lecturer at Flinders University.
Here’s what we learnt from our panellists:
When did you first realise you needed to learn more about end-of-life communication/skills. How did you learn?
For our panellists, the realisation came early in their careers when they encountered difficult conversations that left them feeling unprepared. David Holden, who had years of experience in emergency and intensive care, attended his first formal communication training at the very end of his palliative care training. He described the experience as “peeling an onion” - painful but transformative - and very, very valuable.
Melissa Bruno recalled an early experience as a nursing student when she falsely reassured a dying patient due to her own discomfort. The patient was having a catastrophic bleed. A very experienced nurse modelled a different approach, calmly sitting with the patient and providing comfort. That moment shaped Melissa’s understanding of the power of presence and honesty.
Sara Fleming’s moment of realisation came when a young oncology patient asked her directly, “Am I dying?” She felt unprepared, didn’t know how to respond and knew she needed to develop the skills to engage in these conversations with confidence and care.
The power of language in end-of-life care
The language we use matters. Using clear, direct, and compassionate words helps ensure patients and families understand what is happening. While euphemisms like “passing on” may feel gentler, they can also create confusion. Melissa emphasised the importance of using the word dying kindly and with care.
Non-verbal communication is just as crucial - sitting at the patient’s level, maintaining an open posture, and offering a gentle presence all contribute to meaningful interactions.
Responding to challenging questions
Patients and families often ask challenging questions. Here are some responses from our panellists:
- Am I dying?
- Rather than rushing to answer, take a moment to pull up a chair and listen. Responses like “That’s a big question. Tell me more about what you’re thinking” create space for a deeper reflection and conversation.
- Am I going to suffer?
- Again, show curiosity. Ask Where does that question come from? Then listen to the patient’s response. Reassure the patient: “We will do everything we can to keep you comfortable. If anything feels difficult, please tell us so we can help.”
- How long have I got?
- There’s no exact science to prognostication. David recommends responding with, “That’s an important question. What makes you ask that now?” This helps explore the patient’s concerns before discussing timeframes. Replying in broad timelines is best (weeks/months) always adding, "I can’t say for sure or would you like to know more about what may happen?"
- My Mum was fine last week, now she’s sleeping all the time. You’re not feeding her - she’ll waste away.
- Always show concern and assess the family caregivers own suffering and ill-ease, for example “you must have all been through a lot – how do you think your Mum has been over the past few weeks?” Acknowledge and gently explain the body’s natural process: “Her body is slowing down, and she’s no longer feeling hunger in the same way. We can focus on keeping her comfortable in other ways. This is what we expect."
- Don’t tell my father he has cancer!
- Explore the request further: “Tell me more about what you’re worried about.” If the patient has capacity, it’s important to ask them how much they want to know.
- Is it okay to cry? Is it okay to hug?
- Absolutely. But as Sara noted, it’s important to manage emotions appropriately: “It’s okay to cry, but don’t cry more than the family.” Hugging should always be led by the patient or family, with clear permission.
- How do I discuss end-of-life while maintaining hope?
- Hope is not just about cure; it can shift to hope for comfort, dignity, or quality time. David emphasised, “It’s about what we can do, rather than what we can’t.”
Three key take home points from the panel:
- Be Clear and Compassionate – Use simple, direct language and listen deeply.
- Silence is Powerful – Giving space for reflection allows patients and families to process emotions.
- Keep Learning – Communication is a lifelong skill. Keep refining it through training, observation, and self-reflection.
End-of-life conversations require courage, empathy, and practice. While they may never be easy, they can be deeply meaningful -and even transformative - for those involved.
A heartfelt thank you to our expert panel for sharing their wisdom, and to all healthcare professionals committed to improving these vital skills.
Learn more about extending your communication skills in the free End-of-Life Essentials education module ‘Communication and Decision Making’.