 When and How to Initiate Discussion About Prognosis and End-of-Life Issues with Terminally Ill Patients The researchers wanted to explore by whom, how, and when discussions about
prognosis and end-of-life issues should be initiated with terminally ill patients,
and the context in which these issues can be optimally discussed. They conducted
focus groups and interviews with 19 palliative care (PC) patients, 24 caregivers,
and 22 PC health professionals (HPs). Participants had disparate views regarding
by whom and when such discussions should be initiated, although a similar range
of perspectives was expressed by all participant groups. Four main approaches
were identified: wait for the patient/caregiver to raise the topic; HPs to offer
all PC patients and their caregivers the opportunity to discuss the future (preferred
by the majority of participants); HPs to initiate the discussion when the patient/family
need to know; or HPs to initiate the discussion when the patient/family seem
ready. Four themes emerged regarding the best context of the discussion: importance
of the relationship with HP, clarifying the patient/caregivers' understanding
and how much detail they want to know, negotiating who should be present during
the discussion, and who should deliver the information. Initiating prognostic
discussions with terminally ill patients requires considerable skill and sensitivity.
Communication skills training for professionals may optimize these discussions.
Clayton JM, Butow PN, Tattersall MH. Adapted from J Pain Symptom Manage. 2005
Aug;30(2):132-44. |
| Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York City ©2005 Continuum Health Partners, Inc. www.stoppain.org/palliative_care |
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