Barriers to Communication With Dying Patients—Reply

In reply

We appreciate Dr Reinharth's thoughtful comments concerning why physicians might find communicating with dying patients difficult. Dr Reinharth comments that physicians' fear of patient and/or family anger directed at them may be an additional reason that physicians find communicating with dying patients difficult. One of the investigators in this study conducted a qualitative study to identify patients' and physicians' reasons for not communicating about end-of-life care.^1- 2 Fear of anger was not identified as one of the reasons. If this is an important barrier to communication, then it may be one that patients and physicians are unwilling to discuss. Dr Reinharth also raises the issue of patients sometimes not hearing what they are told. We agree that patients may not hear what they are told. As Dr Reinharth implies in his letter, one of the goals of excellent communication is to understand what patients have heard and the reasons they do not hear what they are told. As our article points out, finding out from dying patients and their families what aspects of communication are important to them provides grounds upon which to establish the necessary dialogues that may substantially improve physician-patient communication and, as a result, quality of care.³