Background: As patients approach the end of their lives, finding the right words to bid farewell and acknowledge the conclusion of their relationship can be a daunting task for health care professionals (HCPs) (1,2). When done well, this final exchange can offer empathy, compassion, gratitude, and perhaps even a sense of closure (1-7). This Fast Fact utilizes expert opinion and anecdotal advice to offer tips and suggested language for final conversations and encounters with patients.

Importance of “saying goodbye” Saying goodbye to patients is a care task often overlooked in healthcare training (which often focuses more on initiating patient interactions) (1). When patients are nearing the end of their life, HCPs often wish to recognize and emphasize the importance of their relationship’s conclusion. However, the same principles can be helpful when an HCP is leaving a practice, when a patient no longer needs their care, or when a pediatric patient transitions to adult care for example (1). By acknowledging the termination of their relationship openly and directly, HCPs can offer dignity and affirmation to the patient and caregivers (2). Not doing so can risk engendering feelings that the HCP was neglectful with follow-up and/or abandoned them (3).

How to “say goodbye” The table below provides techniques found in the published medical literature (1,2,6,10-12). Of note, there is no established method to say goodbye and in general many experts encourage HCPs allow for a more spontaneous encounter that is perhaps less focused on clinical details.

Bottom line: Mastering the art of saying goodbye is an underemphasized facet of medical care that can hold significance for both patients and clinicians.

References:  

1. Back AL, Arnold RM, Tulsky JA, et al. On saying goodbye: acknowledging the end of the patient-physician relationship with patients who are near death. Ann Intern Med. 2005;142(8):682–685. 
2. Mott FE, Marcus JD. The final goodbye. Palliat Support Care. 2013;11(3):277–279. 
3. Epner DE, Ravi V, Baile WF. “When patients and families feel abandoned”. Support Care Cancer. 2011;19(11):1713–1717. 
4. Back AL, Young JP, McCown E, et al. Abandonment at the end of life from patient, caregiver, nurse, and physician perspectives: loss of continuity and lack of closure. Arch Intern Med. 2009;169(5):474–479. 
5. Odagiri T, Morita T, Aoyama M, et al. Families’ sense of abandonment when patients are referred to hospice. Oncologist. 2018;23(9):1109–1115. 
6. Hayek S. How to Say Goodbye: Simple Lessons for the Cardiovascular Physician When Faced With Patient Death. J Am Coll Cardiol. 2019;74(1):154–156. https://doi.org/10.1016/j.jacc.2019.05.036.
7. Dimitrov M. When Doctors Don’t Get to Say Goodbye. Fam Pract Manag. 2023;30(3):31–31.
8. Batty E. Sorry to say goodbye: the dilemmas of letting go in longitudinal research. Qual Res. 2020;20(6):784-799.
9. Heyland DK, Dodek P, Rocker G, et al. What matters most in end-of-life care: perceptions of seriously ill patients and their family members. CMAJ. 2006;174(5):627-33.
10. Block SD. Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: the art of the possible. JAMA. 2001;285(22):2898–2905. 
11. Periyakoil VS. First, Do Not Abandon. J Palliat Med. 2007;10:865-866. 
12. Peck R, Stefanics C. Learning To Say Goodbye: Dealing with Death and Dying. 1st ed. Taylor & Francis; 1987.

Authors’ Affiliations: Valley Health Winchester Medical Center, Winchester WA; Wake Forest University, School of Medicine.
Conflicts of Interest: Dr. Gabbard is supported by the National Institute on Aging of the National Institutes of Health under Award Number K23AG070234. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Version History:  Originally edited by Sean Marks MD; first electronically published in September 2024.