A digital reminder can encourage a clinician to discuss a patient’s end-of-life wishes, opening the door to a conversation that might otherwise be postponed. However, the most meaningful moments often come after that initial question, when a patient shares their fears, a family member struggles to understand the prognosis, or a clinician helps someone navigate an uncertain future.
Research from the University of Pennsylvania demonstrates the potential of electronic prompts. A randomized clinical trial published in JAMA Oncology found that machine-learning-triggered reminders raised documented serious-illness conversations from 3.4% to 13.5% among patients with advanced cancer who were at risk of dying within six months. The intervention also lowered end-of-life chemotherapy by 25%. These findings show how technology can help clinicians begin essential discussions, while reinforcing the importance of preparing healthcare staff to handle the conversations that follow.
These discussions matter because patients and families frequently need to balance treatment options with potential outcomes and their own personal priorities. American Heart Association data show that survival to hospital discharge following adult in-hospital cardiac arrest is 23.6%, compared with a 10.5% survival rate after emergency medical services-treated out-of-hospital cardiac arrest. Such statistics underline the importance of helping patients understand what medical interventions may entail and what recovery could realistically involve.
For healthcare teams, the challenge is making these conversations compassionate as well as clinically informed. Busy hospital wards often provide little time for lengthy discussions, while fear, uncertainty, and different family expectations can make it harder to know what to say. Communication training can give clinicians greater confidence in these situations and help patients communicate what matters most to them.
Amy Hensley, an experienced nurse and end-of-life educator who creates communication workshops for clinical teams, has spent years exploring how healthcare professionals can develop these skills. Her approach began taking shape during an overnight shift early in her nursing career, when an elderly patient sitting on the edge of his bed looked at her through tears.
“He looked at me with tears in his eyes and just said quietly, ‘I don’t want to do this anymore,’” Hensley remembers. Having only recently completed orientation, she was working alone on the night shift and was uncertain how to respond. She sat next to him, held his hands, and listened. Although she understood that promising everything would be fine was not appropriate, she did not yet have the tools to explore what he meant or what he wanted from his care. “I didn’t know how to lead the conversation when he trusted me enough to open up.”
That experience helped shape her belief that communication is a clinical skill that needs to be developed through intentional practice. Hensley remembers receiving a few days of end-of-life simulation training during nursing school, although she recognises that preparation differs between institutions. She worries that clinicians are often expected to manage emotionally challenging conversations without enough opportunities to practice. Simply advising staff to ask open-ended questions, she argues, is not sufficient if they have not learned how to respond to the answers.
Her approach is built around three steps. First, clinicians center themselves by recognising their own emotional state and considering how it may influence their response. Next, they clarify what the patient means, what they understand, and what they hope to achieve. Finally, they offer choices, helping patients understand the options realistically available to them while maintaining a voice in decisions about their own bodies.
This final step becomes especially important when treatment starts to place a significant burden on patients. Hensley challenges the common statement that nothing more can be done, pointing out that palliative care and hospice can still provide meaningful support when curing an illness is no longer possible. “We can switch our focus from trying to cure you and make you as comfortable as you can be,” she explains. The goal is to help patients understand what further treatment might accomplish and whether those outcomes reflect their personal priorities.
Popular depictions of medical emergencies can also influence these decisions. Hensley believes television frequently creates unrealistic expectations about CPR and hospice care, leaving families unprepared for the physical effects of resuscitation or the support hospice can provide. When relatives have not previously discussed a loved one’s wishes, an emergency can quickly turn uncertainty into disagreement. She recalls situations where a relative living far away insists on aggressive treatment, while the family member providing daily care believes the patient would have chosen otherwise.
Recognising a patient’s decline earlier can help prevent these difficult situations. Nurses and certified nursing assistants often notice changes in appetite, sleep, and everyday functioning because of their regular contact with patients. Hensley believes these observations can provide an opportunity to begin discussions before an emergency makes decisions unavoidable, as long as staff have the training and support to raise concerns with sensitivity.
Hospitals must also recognise the emotional impact these encounters can have on their own staff. Hensley describes nurses performing CPR on a frail patient and then almost immediately returning to routine requests from other rooms. Without time to process what has happened, she warns, emotional distress can build up. Communication workshops can offer practical skills, but lasting support also depends on appropriate staffing, opportunities to debrief, and recovery options that reflect individual needs.
The broader institutional challenge is to make serious-illness communication a recognised part of clinical practice, backed by proper training and sufficient time to put those skills into action. Hensley hopes that within five years, these conversations will feel less intimidating for patients, families, and healthcare professionals alike. Electronic reminders can create the opening. Hospitals must equip their teams with the skills and support needed to continue the conversation.
Email: [email protected]
