Discussing End-of-Life Issues

The diagnosis of a life limiting disease or irreversible condition leaves many patients and families with many questions. It is important  for physicians and other health care professions to have discussions with patients and families about their  illness and the kind of care available; what will help, might help, and will not help. It is useful to have a meeting to outline the goals of care, and for the patient and family to understand the purpose of the meeting. There are many resources available to assist physicians and other health care professionals with how to organize this type of meeting as they can be difficult and may include uncomfortable subjects. Some of the things that might assist in having a successful conversation include:

• Find out what the patient and family know; then ask if they have any questions
• Make sure you are attentive to their emotional state and proceed at the patient/family's pace as much as possible
• Keep the conversation moving with facts and empathy
• Talk about what you can do first.  Make sure that you emphasize that there is always something we can do, but it may not be curative
• Make sure they understand the"big picture" before going on to specific issues.

A suggested conversation sound like this---

“I’d like to talk with you today about what is going on with you which will help me understand how to best care for you or your family member.  We will need to discuss the types of treatments available, what will work, what might work, and what will not work and what your goals of care are. After we have that conversation or conversations, we will be able to complete a LaPOST document which is a physician’s order that outlines the plan of care we discussed. This   order will communicate this important information to other members of the health care team so they know how to best care for you during your illness.  This document will transfer with you across care settings (hospital to home to nursing home, hospice).   The LaPOST document can be changed or adjusted at any time as long as it is represents your wishes and goals of care.

A number of resources are listed on the website for assistance in having these difficult conversations.