Aged care staff need support for end of life conversations, study finds

Aged care workers are increasingly expected to guide families through end‑of‑life discussions, but many feel under‑prepared and lack the training, confidence and organisational support needed, according to new research out of Flinders University.

The study, published in the Australasian Journal on Ageing, examined how aged care staff decide when and how to initiate conversations with families about end‑of‑life care. Researchers interviewed 64 staff across 14 aged‑care sites – including registered nurses, enrolled nurses, care managers and support workers – and found that communication practices vary widely across roles and services.

Lead researcher Dr Priyanka Vandersman said staff described end‑of‑life communication as a gradual and evolving process rather than a single moment.

“The ‘right time’ for conversations did not present as a single moment but developed as a cumulative and evolving process,” she said.

The study found that experienced nurses often carry the responsibility for initiating and leading these discussions, highlighting differences in capability across the workforce.

“The prominent role of experienced nurses in leading these conversations suggests an uneven distribution of communication expertise across the workforce,” Dr Vandersman said.

“Our findings suggest a gap between the recognised importance of end‑of‑life communication and its consistent use in practice.”

The research shows that staff rely on their own judgement to determine when families are ready to engage in end‑of‑life planning. Building expectations gradually over time was seen as the most effective way to prepare families for decision‑making, particularly when residents experience slow or unpredictable decline.

“Family dynamics and cultural context shape the communication process, so clear communication helps manage any mismatch in family perceptions of decline,” Dr Vandersman said.

Staff reported that conversations become more challenging under particular circumstances.

“When there is no prognosis or families are reluctant to discuss end‑of‑life plans, staff use various strategies to describe symptoms and changes in an older person’s functions, with experienced clinical staff being more direct about deterioration,” Dr Vandersman said.

The study highlights a need for training to build staff confidence and capability in initiating early and ongoing conversations with families. It also identifies the importance of organisational processes, such as structured prompts, assessment tools and communication pathways, to support staff in having these discussions consistently.

“In practice, training is needed to build staff confidence about initiating early and ongoing conversations with families about end‑of‑life plans for residents,” Dr Vandersman said.

“The use of organisational processes to prompt and structure ongoing conversations can improve practice. Resources to guide staff and family may facilitate discussions and build understanding of end‑of‑life care needs.”

Dr Vandersman said the findings are particularly timely given recent Federal government investment in aged‑care capacity and quality.

“New Federal government investment in aged care capacity and quality, announced in the May 2026 Budget, makes this topic particularly timely,” she said.

“Realising that opportunity depends on what happens at the front line, in every service, every day. To translate that investment into lived experience, services need confidence in when and how to initiate end‑of‑life conversations, clarity about what matters most to residents and families, and practical processes that support staff to have those conversations well.”