unit two: end of life issues. alvin h. moss, m.d. the need for more physician communication with...
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UNIT TWO: END OF LIFE ISSUES
Alvin H. Moss, M.D.
The Need for More Physician Communication with Patients/
Families Facing the End of Life.
West Virginia Medical Journal July/August 2001 Vol. 97, No. 4
What Patients and Families Want
Recognition of Importance of the Patient as a Person
Discussions of Important Decisions before they Occur
Robert Bruckman’s Approach in his book: How to Break Bad
News
Getting Started
Enough Time
No Interruptions
Supporters Present
What Does the Patient Know?
Are they ready?
Is the right support available?
What Does the Patient Want to Know?
If this is serious, do you want to know?
Do you want the details?
Should I tell someone else?
Sharing the Information
Give a “warning shot,” then pause
Tell it (directly), then stop
Responding to Feelings Be Prepared; Be Ready to Be
Silent
Acknowledge Emotion
Expression, touch, offer water, tissue
Planning and Follow-Up
Assure care will continue
Safety and Support
Begin to Discuss Plan
Psychosocial and spiritual issues
Hospice care includes these Uniqueness of experience Identify issues critical to the
patient
Potential Issues
Pain relief Financial and Legal Affairs Relationships Spiritual Issues Philosophical Issues
Some appear to sincerely want to fight death to the end; some welcome it as a friend.
Grief
Models
When is it abnormal?
Predicting Bad Grief Outcomes.
On Death and Dying (Kubler-Ross)
Not always quite as linear
Skip stages; “ping-pong”
How long is normal?
6 weeks extreme distress
2-4 years maximum resolution
Risk for Poor Grief Outcomes
Unexpected Death
Unresolved Active Issues
Financial Hardship/Forced Changes of Plans
Risk for Poor Grief Outcomes
Psychiatric Illness
Ilness not socially Acceptable
Substance Abuse
How do we help?
Be Available
Help identify and validate feelings
Reduce Inappropriate Guilt
How do we help?
Approve Time to Grieve
Refer if Necessary
How Do We help?
We should be there for the patient and family. We should meet their needs, and only after that, our own. If we are not effective, we should refer. We must be careful of our own denial. This a critical part of healing.