Clarifying communication at the end of life

(January 2014) Researchers with a new end-of-life communication study that garnered recent media attention, including from The Boston Globe and local NPR station WBUR, turned to the Health Communication Core (HCC) to help maximize the readability of its innovative "checklist." Boston Globe newspaper headline: Checklist theory used in creating end-of-life talk guide

The study is being conducted at Dana-Farber Cancer Institute by Susan Block, MD and Rachelle Bernacki, MD, in collaboration with Atul Gawande and Ariadne Labs, a joint center for health systems innovation at Brigham and Women's Hospital and Harvard School of Public Health.

An end-of-life conversation guide

The study builds on common palliative care communication approaches and applies the checklist method, which Gawande first applied to reducing surgical errors and then to safer deliveries in India, to end-of-life conversations. It aims to help doctors conduct difficult end-of-life conversations with patients by providing a checklist with seven questions to guide the conversation.

HCC consulted with the study team to assess the literacy level and cultural competency of the checklist and the study’s patient materials, ensuring that the language, examples, and tone would be relevant and easily understood by patients of all backgrounds and education levels.

The checklist seeks to help doctors understand patients’ wishes when they have a life-threatening illness. After the conversation, doctors and patients are surveyed about their experience. Their responses will be compared with doctors and patients who didn’t use the checklist.

The study’s ultimate goal is improved patient care. "The goal of the study is to see if we can improve the number of patients who get the type of care they want at the end of life," said Rachelle Bernacki, MD.