 Beyond advance directives: importance of communication skills at the end of life Patients and their families struggle with making choices about care at the
end of life. Advance directives are often used as a tool to facilitate this
decision making, but sometimes fall short of this goal. The author's discussion
of the case of a man with metastatic cancer, for whom an advance directive was
unable to prevent a traumatic death, reviews the challenges in creating and
implementing advance directives, discusses factors that can affect decision
making, and offers physicians practical suggestions to ease decision making
at the end of life. The patient's daughter, primary care physician, and his
surgeon were interviewed, yielding a multidimensional perspective of a case
unusual in its degree of conflict and that ended in the patient's experiencing
unnecessary pain and a traumatic resuscitation attempt. The author argues that
advance care planning should occur within a framework that emphasizes responding
to patient and family emotions and that focuses more on goals for care and less
on specific treatments. Tulsky JA. Adapted from JAMA. 2005 Jul 20;294(3):359-65.
|
| Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York City ©2005 Continuum Health Partners, Inc. www.stoppain.org/palliative_care |
 |