• end of life care
• communication
• terminal care
• psychological care
• paediatrics
• cancer

White et al 1 highlight that death and dying is everyone’s business, yet is often neglected in the training of multidisciplinary health professionals (MDHP). While physicians play a critical role in end-of-life care, patients interact with a range of health professionals. As such, it is vital that MDHP are also trained in palliative care, including end-of-life communication. Nursing and allied health professionals also spend considerable time with patients developing strong therapeutic relationships fundamental to the success of challenging conversations when adjusting to incurable illness.2 3

Nevertheless, White et al’s survey noted considerable variability in the availability of palliative care and end-of-life-related content in UK-based undergraduate nursing and allied health courses. Only 16% of the social work courses surveyed included such training. Similarly, in Australia, 96% of MDHP perceived that their undergraduate education had underprepared them for the clinical realities of working with palliative care patients.4

Consistent with identified gaps in the literature, White et al’s survey did not include psychologists. Psychologists are ideally placed to provide specialist end-of-life care as they are already trained in sophisticated communication skills and have the capacity to navigate challenging emotional terrain. Assisting individuals grappling with uncertainty, anxiety, grief and loss, demoralisation and hopelessness is psychologists’ ‘core business’. Further training to apply these high-level therapeutic skills to end-of-life care is critical. Vivekananda et al interviewed psychologists, many of whom had specialist end-of-life experience (21/35, 60%) and identified core domains in which psychologists should contribute to end-of-life care (table 1).5

There is much to be gained through better integration of psychology into end-of-life care and communication—yet currently, discipline-specific end-of-life training for psychologists appears rare. We collected pilot data from Australian clinical psychologists on their experiences in end-of-life communication and their training needs. Led by the first author, a 1-day experiential workshop on end-of-life communication focused on tailoring these skills to the needs of adolescents and young adults with life-limiting illness (2019). Most clinical psychologists in this small-group workshop (n=11) worked in private practice (n=7, 64%), with an average of 10 years’ professional experience (range=0–32 years, SD=10.21), yet with little experience working with young people with incurable illness (none had worked with a young person who had died). Over a third of participants stated that experiential opportunities to practice skills were the most valuable part of the workshop (n=4, 36%). When asked about barriers that prevented them from facilitating these conversations, ‘not having the skills personally or knowing how to start’ was the main barrier (n=7, 64%).

Our sample identified workshops as the most helpful training method to equip them in future (n=8, 72%), followed by experiential training, hard-copy resources and video resources (n=6, 55% for each). At the conclusion of the workshop, most of our sample still reported moderate anxiety with respect to discussing end-of-life with patients and their families (n=7, 64%). Effective training in end-of-life care is likely to require repeated, experiential learning opportunities.3

Psychologists are well equipped to identify and address the natural and common phenomenon of death anxiety. In addition to facilitating end-of-life communication directly with patients and families, psychologists can support the multidisciplinary team with group-level reflective practice as the team grapples with their own death anxiety. Psychologists’ expertise could be woven into interprofessional training, that is, through innovative ‘team member as teacher’ models.3

Ultimately, the evidence-to-practice gap in end-of-life communication is an implementation problem beset by numerous barriers.2 5 Some barriers—such as the complexity and unpredictability of care towards end-of-life—could be addressed by more clinicians on the multidisciplinary team being well trained to support these conversations. As patients will develop stronger rapport with different health professionals, any health professional may become the person a patient chooses to speak to—whether a radiation therapist, a night-shift nurse or a psychologist. Advanced communication skills are crucial for health professionals to feel confident about transforming a patient’s lingering question to a meaningful conversation about their end-of-life priorities. Equipping MDHP to identify and act on appropriate openings for end-of-life conversations increases the likelihood that these sometimes fleeting conversational moments are embraced. This is especially important when working with seriously ill young people, for whom the autonomy and agency involved in choosing who they confide in and when is critical.2 3

One strategy to build both skills and confidence from the start of health professionals’ careers might be to expand access to undergraduate-level training resources, such as the Australian Government-funded ‘Palliative Care Curriculum for Undergraduates’ (https://pcc4u.org.au). Rather than locating expertise (and responsibility) within specific healthcare disciplines, skills in end-of-life communication deserve to be distributed across the multidisciplinary team.

Being mortal is arguably the most human quality. We advocate that improving the training and integration of psychologists into end-of-life communication and care is a crucial development that needs to take place, both in clinical practice and research, to benefit the mortal humans at the heart of the healthcare system.