Abstract #3  -  End-of-Life Care Communication Barriers for Doctors and Patients
Authors:   Presenting Author:   Dr Elena Vvedenskaya - Regional Centre for AIDS Control
Additional Authors:  Dr Grigory Moshkovich, Ms Oxana Shilova,
Aim: To identify barriers to optimal doctor-AIDS patient communication about death and end-of-life care in Russia and strategies to overcome them.Deaths from HIV/AIDS among young adults will continue to grow in Russia despite the availability of HAART. Research suggests that communication about end-of-life care is a very hard job and some essential barriers to this communication exist.
Method / Issue: We conducted a prospective study of 27 patients with advanced HIV/AIDS disease and their doctors who were recruited from the regional AIDS Centre and city clinics. Barriers to end-of-life communication were identified and assessed for frequency and importance and for an association with the occurrence and quality of end-of-life communication.
Results / Comments: Doctors have demonstrated more barriers than patients. The most common barriers include doctors’ beliefs, poor education in end-of-life care, patients’ characteristics, medical system limitations, and attitudes to AIDS and death in the community. Among the barriers the following were named: “the prognosis is very uncertain”, “the patient isn't ready to talk about end-of-life”, “it is too difficult to talk about death”, and “our opportunities for caring is too limited”. Some changes of the health care system were proposed to improve the doctor-patient communication.
Discussion: Doctors’ barriers are numerous and more common than patients’ barriers. Doctors should identify personal psychological type of a patient and meet his/her individual needs talking about end-of-life care. Doctors’ and patients’ barriers could be addressed through education, advance planning, involving patients' family members, and individualizing care. Cultural and systems problems can be addressed through public and professional education, alternative models of care, and changing the attitude of the society to AIDS and the death phenomenon.
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