Understanding Clinicians' Perspectives on End-of-Life Dreams and Visions: An International Survey.

Clinicians frequently encounter end-of-life dreams and visions (ELDVs) in patients with serious or terminal illness, but they feel underprepared to respond. A survey of 247 health care professionals found that participants perceived positive effects of ELDVs on patients more often than negative effects. The most commonly reported clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than other challenges. Participants endorsed multidisciplinary involvement and formal policy implementation. There is a need for structured training and institutional protocols to address ELDVs in clinical care.

Study at a glance

Abstract

End-of-life dreams and visions (ELDVs) are vivid, often subjective experiences that occur during the dying process. Even though the patient and family experiences of ELDVs are well documented, there is limited knowledge regarding the perspectives, preparedness, and perceived needs of health care professionals. ELDVs also remain insufficiently addressed in clinical care. To describe how frequently clinicians encounter ELDVs, perceived preparedness/training, and approaches to clinician and family education and communication. We conducted a survey to explore health care professional's perspectives and experiences surrounding ELDVs. The Checklist for Reporting Results of internet E-Surveys was followed. Our survey included 30 items across 7 sections. Professionals that take care of patients with serious or terminal illness were eligible for the study. We utilized a structured multimodal dissemination to achieve maximum diversity in participants. Briefly, 247 participants were eligible for analysis. Frequent encounters for ELDVs were reported by participants. Participants perceived positive effects on patients more frequently than negative effects (W = 446.0, p < 0.001, r = 0.64). Clinical challenges were rated differently across categories (χ2 = 160.97, p < 0.001, Kendall's W = 0.13). The most commonly endorsed clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than all other challenges (Bonferroni-corrected Wilcoxon tests: All p < 0.001). Participants endorsed multidisciplinary involvement and formal policy implementation. ELDVs are common, but clinicians feel underprepared to respond to them. There is a need for structured training and institutional protocols. Future studies should include patients and their families and analyze how their experiences are shaped by physician responses.