4/10/2023 0 Comments Making mr right endingI have formulated a 4-step approach, based on structured interviews at a major university hospital with five faculty clinicians experienced in the care of dying patients. This article provides physicians with practical tools for addressing fundamental end-of-life issues with patients and their families. But in the vast majority of cases, patients and family members are aligned, and end-of-life care can be managed in a sensible and conflict-free manner. In rare instances, patients and family members may have major disagreements, or futile treatments may be demanded. 5, 18, 19 They want the last days, weeks, and months to pass without pain, to be spent harmoniously with family and close friends, preferably at home in familiar surroundings. When curative treatments are no longer effective, most patients and families desire that aggressive interventions be avoided. 13 – 17Īs death approaches, many patients have relatively modest needs and desires. By involving family members in these discussions, relationships within the family can be strengthened, and can reduce the isolation experienced by the dying person. 4, 11, 12 Open and direct discussions can ease many of these fears. Dying patients experience fear of pain, fear of indignity, fear of abandonment, and fear of the unknown. 11 Most patients, as they near death, contend with similar fears, needs, and desires. Discussions that focus solely on resuscitation fail to recognize important physical and psychosocial concerns. 7, 8 Physicians must therefore accept responsibility to initiate timely dialogue, as many patients will wait for their physician to raise the subject.Įnd-of-life discussions should address a broad array of issues central to the dying patient and family. Good communication can help allay fears, minimize pain and suffering, and enable patients and their families to experience a “peaceful death.” 4 Poor communication can result in suboptimal care, and patients and their families may be subjected to undue mental or physical anguish.Ī large majority of patients are interested in discussing end-of-life care with their physician, 5 – 10 and most believe that physicians should introduce the topic. 2 Physicians must recognize that quite the contrary is true. 1 – 3 Thus, in our death-averse society, 4 it is not surprising that many physicians find it difficult to engage in end-of-life discussions.ĭeath has long been regarded as tantamount to medical failure, which implies that physicians have nothing to offer a dying patient and family. Physicians are trained to maintain health and fight illness, but typically receive little guidance on how to communicate with dying patients and their families. By following these 4 steps, communication can be enhanced, fears allayed, pain and suffering minimized, and most end-of-life issues resolved comfortably, without conflict. This paper presents a practical 4-step approach to conducting end-of-life discussions with patients and their families: (1) Initiating Discussion, (2) Clarifying Prognosis, (3) Identifying End-of-Life Goals, and (4) Developing a Treatment Plan. Good communication can facilitate the development of a comprehensive treatment plan that is medically sound and concordant with the patient's wishes and values. Instead, such discussions should address the broad array of concerns shared by most dying patients and families: fears about dying, understanding prognosis, achieving important end-of-life goals, and attending to physical needs. End-of-life discussions, however, must go beyond the narrow focus of resuscitation. Most expect their physician to initiate such dialogue. A large majority of patients and close family members are interested in discussing end-of-life issues with their physician.
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