Clinician Barriers to Values / Wants / Needs Discussions Regarding Palliative Care

Clinicians face multiple barriers when conducting a discussion on the personal values, wishes, and needs (VWN) with patients receiving palliative care, according to a systematic review published in Palliative Care & Social Practice.

To guide appropriate and optimal palliative care for patients, clinicians should understand the patient’s VWN. This review was designed to assess the barriers of communication about VWN in the palliative care setting from the clinicians’ perspective. 

Investigators from University Medical Center Utrecht in the Netherlands searched publication databases through December 2022 for relevant studies. A total of 29 articles were included in the review, and the investigators formulated 5 synthesized findings.

Professional manners Clinicians reported that professional manners were a barrier to VWN communication. For example, the patient’s disease trajectory affected the clinician’s self-confidence to initiate the VWN conversation. Some clinicians worried that the VWN conversation would take the patient’s hope away.

Image of patients/families Clinicians also reported creating an image in their mind about patients and patients’ loved ones. Their perception of how they thought the patient and/or family would react to the patient’s prognosis was a hinderance to initiating the VWN conversation.

Human aspect Clinicians’ own emotions related to patients’ and families’ emotional or psychological discomfort affected their ability to initiate the VWN conversation. in this context the barrier was the clinician’s discomfort.

Multidisciplinary collaboration Palliative care is often delivered by a multidisciplinary team. Many clinicians expressed uncertainty about who among the team should be responsible for conducting the VWN conversation.

Contextual preconditions The last barrier to the VWN conversation was the conditions seen as necessary to discuss VWN, such as a lack of time and/or sufficient privacy to engage in the conversation.

A major limitation of this review was that it did not include patient perspectives.

The review authors concluded, “Our findings emphasize the need for the development and integration of a systematic approach to improve on-going attention for the patients’ VWN in clinical practice and translation of these VWN into individualized care during the patient trajectory.”