Attitudes must change if we are to achieve a good death for all, say experts

By 2030 the annual number of deaths around the world is expected to rise from 58 million to 74 million, but too many people still die alone, in pain, without dignity, or feeling alienated.

The articles aim to remedy this by exploring how lessons learnt from end of life care for cancer patients can be adapted for those dying from chronic conditions like heart failure and dementia.

"Palliative care beyond cancer" also topped a recent BMJ poll of topics respondents wanted to read more about, suggesting that doctors are keen to be more open about death and deliver better end of life care for their patients.

In the first article, Scott Murray and Kirsty Boyd say that the ability to make an accurate and timely diagnosis of dying is "a core clinical skill that could be done better in all care settings." They believe that education and training of staff are central to the success of end of life policies in the UK.

The need for mandatory training is supported by Professor John Ellershaw and colleagues who argue that to achieve a good death for all "we need a fundamental shift of emphasis." They say "we must strive to ensure that a good death is the expectation rather than the exception in all settings."

In another article about having the difficult conversations about the end of life, GP Stephen Barclay and oncologist Jane Maher believe that clinicians need to create repeated opportunities for patients to talk about their future and end of life care, while respecting the wishes of those who do not want to discuss such matters. "The right conversations with the right people at the right time can enable patients and their loved ones to make the best use of the time that is left and prepare for what lies ahead," they write.

Talking about dying is also the subject of an article by Professor Jane Seymour and colleagues. They say: "Eradicating ignorance among clinicians, patients, and the public about what can be achieved with modern palliative care and encouraging dialogue about end of life care issues are important means of changing attitudes."

Finally, Professor Aziz Sheikh and colleagues at the University of Edinburgh explore how the spiritual needs of dying patients can be understood and met in pluralist and secular societies. They believe healthcare workers "need to be aware of their role in listening to patients, their carers and families, and others in the wider healthcare system with knowledge and understanding of the nuances of religious and cultural traditions."

This special supplement has been supported by the British Heart Foundation and the National Council for Palliative Care.

In spring 2011, the BMJ Group launches a new journal in this field: BMJ Palliative and Supportive Care.