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Communication in End of Life Care

Communication in End of Life Care. M4 ICE Seminar. Words Matter. See PERL cards Can lead to sense of abandonment- “Nothing more we can do” “Time to stop . . .” Can interfere with therapeutic relationship and rapport. Can lead to poor pt/family decisions. Breaking Bad News.

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Communication in End of Life Care

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  1. Communication in End of Life Care M4 ICE Seminar

  2. Words Matter • See PERL cards • Can lead to sense of abandonment- • “Nothing more we can do” • “Time to stop . . .” • Can interfere with therapeutic relationship and rapport. • Can lead to poor pt/family decisions

  3. Breaking Bad News Bad News – Any info that may negatively affect a patient’s physical or mental health.

  4. Getting started What does the patient know? How much does the patient want to know? Sharing the information Responding to patient, family feelings Planning and follow-up SETTING PERCEPTION INFORMATION KNOWLEDGE EMPATHY SUMMARIZE / STRATEGIZE S- P- I- K- E-S Protocol Adapted from Robert Buckman, Breaking Bad News

  5. ELICIT BIG-PICTURE GOALS AND VALUES • What makes life worth living? Want to get up and face each day? • Is anything worse than death? • What do you think she’s hoping for? • If this is the last chapter of her life, is there something she needs to do or accomplish?

  6. CLOSE THE MEETING • Any contingency decisions? • Summarize and check for agreement • Arrange for follow-up

  7. WHY THINGS GO BADLY • What’s the problem?

  8. DDX OF CONFLICTGoold, Williams, Arnold JAMA 2000 • Family does not understand • Denial (superficial resemblance) • Grief • Guilt • Secondary gain? • Family/physician values conflict

  9. CONCLUDING THOUGHTS • Families may remember you the rest of their lives • Emphasize goals, outcomes, values (from the patient’s perspective) • De-emphasize treatments and technologies

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