Doing better at 'difficult discussions': Australianoncology professionals' perspectives on end-of-life communication with adolescents and young adults with cancer

Abstract

Aims: Adolescents and young adults (AYAs) with cancer face complex psychosocial and medical challenges.1-3 AYAs report wanting honest conversations around their illness.4-6 Supporting age-appropriate conversations about end-of-life topics, at the right times, is critical.4-6 There is currently no best-practise guidance for communication of endof-life topics with Australian AYAs with cancer, and evidence indicates that current practises could be improved.3, 7-9 We explored the perspectives of healthcare professionals (HCPs) caring for AYAs with cancer, to better understand and improve the quality of current end-of-life communication practises. Methods: Semi-structured interviews were conducted with a range of HCPs from pediatric and adult sectors, including medical, nursing, and allied health staff who had cared for at least one AYA with cancer who had died. Interviews focused on perceived barriers and facilitators to high-quality end-of-life communication, and preferences for improving current practise. Results: Twenty-seven HCPs were interviewed (82% females; mean age = 42 years, SD = 9.09). HCPs represented a range of disciplines and experience (mean years practising = 17, range = 5-30) and most had cared for >15 AYAs who died from cancer (74%). Most HCPs reported experiencing some anxiety about facilitating end-of-life conversations (70%). The two most frequently reported barriers to highquality, timely end-of-life communication with AYAs were an excessive focus on treatment (n = 9; 33%) and a lack of support from patients' families (n = 8; 29%). The most frequently-reported facilitators were having a structured tool (n = 6; 22%) and preestablished honest communication with patients (n = 6; 22%). HCPs frequently indicated that the clinician best-placed to facilitate these conversations was whomever theAYAhad the best relationshipwith, regardless of discipline (n = 15, 55%). Conclusions: Australian oncology HCPs are highly engaged and motivated to support end-of-life conversations with theirAYApatients. The lack of consensus around “when” is the optimal time to introduce these issues reflects the complexity of developing and implementing goldstandard practises in this area.L6193516222017-11-27 <br />