Communicating with patients and their families about advance care planning and end-of-life care

Discussing dying and death with patients and their families is an extremely important part of providing good quality care for patients with chronic pulmonary diseases and families of patients in the ICU. While there is little empirical research to guide clinicians in determining the right time or the most effective way to have these conversations, there is a developing experience and an increasing emphasis on making this an important part of the care we provide and an important part of training for students. Much like other medical skills, providing sensitive and effective communication about end-of-life care requires training and practice as well as planning and preparation. While different clinicians may have various approaches and may change their approaches to match the needs of patients and their families, this article reviews some of the fundamental components to discussing end-of-life care in hospital and outpatient settings that should be part of the care of most patients with life-threatening illnesses in the ICU.