Intended for healthcare professionals


Why is talking about dying such a challenge?

BMJ 2014; 348 doi: (Published 06 June 2014) Cite this as: BMJ 2014;348:g3699
  1. Kirsty Boyd, consultant in palliative medicine1,
  2. Scott A Murray, St Columba’s Hospice chair of primary palliative care2
  1. 1Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Primary Palliative Care Research Group, Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK
  1. Scott.Murray{at}

Much more needs to be done to encourage the conversation

In May, Stephen Sutton died at the age of 19 years from bowel cancer. His love of life and extensive fundraising showed everyone how to live life to the full, even when dying. Death is universal. But most patients and doctors still struggle to deal with the challenges posed by deteriorating health and thinking about dying. How and where people die depends not only on their disease but on their circumstances, options, choices, expectations, values, and beliefs. Open, early discussions about what matters when people are dying are vital if we are to act on the growing list of policies, good practice guidance, and recommendations.

A recent survey of 2055 British adults commissioned by the health promoting palliative care organisation “Dying Matters” found that about half of those with a partner knew about their partner’s end of life wishes. Just 6% had written down their own preferences despite sustained campaigns to encourage public and professional engagement in advance care planning. A parallel study found some improvement in the proportion of GPs who had initiated a conversation with patients about end of life care (75% in 2014 v 65% in 2012).1 The timing of these discussions was not reported, but a Scottish primary care study found that patients with cancer or other advanced illnesses were being identified for a palliative care …

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