HMN 2026: How More support is needed for aged care staff to steer end-of-life conversations

A new study from Flinders University researchers describes the perspectives of aged care staff on when and how they communicate with families to plan end-of-life care—and identifies that increased training and resources are needed to properly equip aged care staff for appropriate engagement with families. The work is published in the Australasian Journal on Ageing.

“The ‘right time’ for conversations did not present as a single moment but developed as a cumulative and evolving process,” says Dr. Priyanka Vandersman, Senior Research Fellow for Research Center for Palliative Care, Death and Dying [RePaDD] at Flinders University. “The prominent role of experienced nurses in leading these conversations suggests an uneven distribution of communication expertise across the workforce.

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

The researchers sought the perspectives of 64 aged care staff (a mix of registered nurses, enrolled nurses, care managers and support workers) about end-of-life care conversations with families. Using interviews, focus groups and inductive thematic analysis, the researchers identified the delicate judgment required for timing these conversations, and that building expectations over time best prepares families for decision-making.

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

She says that while aged care staff are committed to engage with families early, they often face barriers when talking about end-of-life.

“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. Therefore, confidence, role clarity and medical endorsement influence communication.”

Findings highlight the need for training to build staff confidence to initiate early and ongoing communication with families. Resources for both staff and families may facilitate discussions and enhance the quality of end-of-life communication and care outcomes in aged care settings.

“New Federal Government investment in aged care capacity and quality, announced in the May 2026 Budget, makes this topic particularly timely,” adds Dr. Vandersman. Realizing 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.

“The findings from this study shed light on how those complex interactions are experienced by staff, and suggest ways in which this relational aspect of care might be better recognized and supported.”

These findings have practical impacts at both a policy level, and in clinical practice. They show that enhanced workforce capability and systematic palliative care assessment processes are needed—and emphasizes the gap between the recognized importance of end-of-life communication and its consistent enactment in practice.

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

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