Doctors and Nurses Say No One Taught Them How to Talk About Dying

Death is the one certainty that modern medicine is built to fight, yet the people who stand at the bedside when the fight is lost say they were never properly taught what to do next. A new qualitative study from Portugal, published in the journal Trends in Psychology, has given voice to healthcare students and professionals about their experiences caring for terminally ill patients and supporting their families, and the picture that emerges is strikingly consistent: insufficient training, scarce resources, communication barriers, and difficulty managing emotions are converging to undermine the quality of care delivered at the end of life. The research, led by Alexandra Neto of the University of Porto together with Félix Neto and Patrício Costa, set out not merely to document these problems but to use them as the foundation for a training program designed to improve communication and emotional management among those who accompany the dying.

The methodological approach was deliberately exploratory and qualitative. Rather than distributing questionnaires and crunching numbers, the researchers conducted semi-structured interviews with healthcare students and professionals, allowing participants to speak at length and in their own words about death, dying, and the support offered to families. The interview transcripts were then analyzed thematically using IRAMUTEQ, a free software package that interfaces with the R statistical environment to perform multidimensional analyses of textual data. This kind of computer-assisted lexical analysis allows researchers to identify recurring word clusters and thematic worlds within large bodies of text, providing a systematic and reproducible way to map what participants emphasized, avoided, and connected. The choice of method matters: perceptions of death are slippery, culturally loaded, and often unspoken, and a purely quantitative instrument might have flattened exactly the nuances the team was trying to capture.

What the analysis revealed was a set of interlocking limitations that participants described as shaping, and often constraining, the care they could provide. The first was educational. Participants reported that their formal preparation for end-of-life care was inadequate, a finding that echoes a substantial international literature. Systematic reviews of undergraduate palliative care teaching across Europe, China, Latin America, Austria, and New Zealand have repeatedly documented that palliative medicine occupies a marginal place in medical and nursing curricula, and surveys of students consistently show low confidence and limited knowledge when it comes to managing dying patients. The Portuguese participants in this study experienced that gap firsthand, describing a professional world in which they were expected to accompany patients through the most difficult passage of their lives with little structured guidance on how to do it.

The second limitation was structural. Participants pointed to resource constraints that made high-quality end-of-life care difficult to deliver, a complaint that resonates with reports from the Portuguese Palliative Care Association, which has warned that significant gaps in palliative care provision persist in Portugal alongside institutional inertia to resolve them. Access barriers to palliative services in hospitals have been documented in mixed-methods systematic reviews across multiple countries, and studies of nursing practice in palliative settings have even identified the self-rationing of care, in which nurses quietly triage which needs they can address because time and staffing fall short. In other words, the problem the Porto team identified is not simply a matter of individual skill or will; it is embedded in systems that ask clinicians to perform emotionally and technically demanding work without adequate tools, personnel, or institutional backing.

The third and perhaps most psychologically charged limitation concerned communication. Participants described barriers to talking honestly with dying patients and their families, a difficulty that clinicians around the world will recognize. Research on end-of-life discussions in oncology has documented both actual and missed opportunities for these conversations, and qualitative work on breaking bad news has shown a persistent disconnect between what is taught in classrooms and what students feel prepared to do at the bedside. Talking about death forces clinicians to confront their own mortality, a dynamic long theorized in terror management research, and many default to avoidance, euphemism, or technical language that shields them as much as it confuses families. The participants in the Portuguese study were candid that this avoidance damages the therapeutic relationship precisely when it matters most, leaving patients and loved ones uncertain, unprepared, and sometimes unable to say the things that give dying its meaning.

Hand in hand with communication barriers came the fourth limitation: difficulty managing emotions. Caring for terminal patients is not emotionally neutral work, and the participants described the strain of witnessing suffering and death without adequate psychological support or training in emotional regulation. The wider literature is unambiguous about the stakes. Studies of oncology nurses have linked repeated exposure to patient death with secondary traumatic stress, moderated in part by empathy, and cross-sectional research has connected confrontation with suffering and death to burnout and diminished wellbeing among professionals. Qualitative studies of nursing home staff describe the emotional labor of closing the door, wiping away sadness, and putting on a smiling face. A recent scoping review has even described professional grief in healthcare as hidden in plain sight, an experience so routine that institutions rarely acknowledge it. The Porto participants’ struggles, in this light, are not personal failings but predictable responses to an occupational reality that healthcare systems have chosen not to address.

Woven through all of these themes was the family. Participants emphasized that end-of-life care is never delivered to a patient in isolation; it is delivered to a web of relatives who are frightened, exhausted, and often unprepared for what is coming. International qualitative research has described family involvement in end-of-life care as work that someone must do, frequently falling to relatives without training or support, and integrative reviews have shown that interventions promoting family participation measurably enhance the quality of care for hospitalized patients. The Portuguese participants recognized that supporting families requires its own distinct set of communication and emotional skills, distinct from those needed for the patient, and that these too were absent from their education. When clinicians cannot manage these conversations, the burden shifts silently onto families, who must navigate the dying process with even less preparation than the professionals at the bedside.

The study’s authors argue that these findings point directly toward a solution: targeted educational programs that equip healthcare professionals and students with concrete skills in communication and emotional regulation. The evidence base for such training is genuinely encouraging. Systematic reviews of intervention trials for healthcare professionals have found that palliative care training programs can be effective, and meta-analyses of randomized controlled trials teaching palliative care to health professional students support the value of structured education. Educational interventions ranging from death preparation programs for nurses to simulation-based communication training and blended-learning courses on discussing approaching death have shown measurable improvements in death anxiety, attitudes toward end-of-life care, and perceived competence. Interprofessional education programs and student Schwartz rounds, which bring multidisciplinary teams together to discuss the emotional dimensions of care, represent additional promising formats. The Porto team’s training program is conceived as a response to the specific gaps their participants named, grounded in the actual language and concerns of the clinicians and students who will use it.

What makes this study resonate beyond Portugal is how faithfully it mirrors a global condition. The Lancet Commission on the Value of Death argued in 2022 that death has been too thoroughly medicalized and must be brought back into life, into homes, communities, and honest conversation. The experiences recorded in this Portuguese study, from the first patient death a nursing student witnesses to the seasoned professional’s quiet exhaustion, illustrate exactly what happens when that commission’s warning goes unheeded at the level of individual training. Medicine has become extraordinarily adept at prolonging life, but the skills of accompanying death, of speaking plainly with the dying and holding space for their families, remain treated as optional extras rather than core competencies. The result is a workforce that describes itself as unprepared for one of the most meaningful tasks it will ever perform.

The researchers are careful about the limits of their design. An exploratory qualitative study with semi-structured interviews cannot quantify the prevalence of these perceptions or establish causal relationships between training deficits and care quality, and the findings are shaped by the specific context of Portuguese healthcare education and by the participants who chose to speak. Data from the study are available upon reasonable request from the corresponding author, and the work received ethics approval from the Faculty of Psychology and Education Sciences at the University of Porto, with all participants providing written informed consent. Yet the convergence between these interview findings and the international quantitative literature gives the conclusions considerable weight. If the study’s central recommendation is taken seriously, the payoff could be substantial: clinicians who can talk about dying without flinching, who can regulate their own grief while remaining present, and who can extend genuine support to families, transforming the end of life from a medical failure to be managed into a human passage to be accompanied with skill and compassion.

Subject of Research: Healthcare students' and professionals' perceptions of end-of-life care, family support, and palliative care education

Article Title: Healthcare Students’ and Professionals’ Perceptions on Care and Education in End-of-Life and Family Support

Article References: Neto, A., Neto, F., & Costa, P. (2025). Healthcare Students’ and Professionals’ Perceptions on Care and Education in End-of-Life and Family Support. Trends in Psychology. https://doi.org/10.1007/s43076-025-00506-3

Image Credits: AI Generated

DOI: 10.1007/s43076-025-00506-3

Keywords: palliative care, end-of-life care, healthcare education, qualitative research, communication, emotional regulation, nursing, death anxiety, family support, medical training, burnout, Portugal