Post on 08-Feb-2017
10
Communication at the End of Life SMACC 2015
Chicago
#smaccUS#FOAMcc#HPM @expensivecare
10
Communication at the End of Life SMACC 2015
Chicago
#smaccUS#FOAMcc#HPM @expensivecare
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AbeThe Patient
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Dr. NickThe Doctor
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HomerMargeBartLisaMaggieThe Family
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The Family Meeting
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Hi everybody!
The Patient has septic shock with an unclear source.
His MAP is 60 on an infusion of 40mcg/kg/min of noradrenaline. He has a lactate of 9 and a bicarb of
12.
He’s anuric and his creatinine is 350.
Do you want us to do everything?
The Family Meeting
Is there a problem?
Is there a problem?
Can communication be taught?
Is there a problem?
Can communication be taught?
What do the experts do?
Is there a problem?
Can communication be taught?
What do the experts do?
What about the difficult situations?
22% of Americans die in ICU
22% of Americans die in ICU
90% following planned withdrawal of care
22% of Americans die in ICU
90% following planned withdrawal of care
54% of families have poor understanding of diagnosis, plan and prognosis
Levin GenHospPsych 2010
hellomynameis.org.uk
Family Talking
Doctor Talking
McDonagh CCM 2004
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The Medical Expert
The Values Experts
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The Medical Expert
The Values Experts
Turnbull CCM 2014;Schneunemann CCM 2015
Autonomy
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The Medical Expert
The Values Experts
Turnbull CCM 2014;Schneunemann CCM 2015
Autonomy
Substituted Judgement
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The Medical Expert
The Values Experts
Turnbull CCM 2014;Schneunemann CCM 2015
Autonomy
Substituted Judgement
Best Interests
Doctor Decides
Patient Decides
Patient Preferences for decision making
Doctor Decides
SharedSurrogate Decides
Surrogate Preferences for decision making
Johnson AJRCCM 2011Chung JME 2011
Is communication aclinical skill?
Image: lifeinthefastlane.com
Hope AATS 2015
McAllister AATS 2015
Hope AATS 2015
McAllister AATS 2015
Hope AATS 2015
Curtis JAMA 2013
Value
Acknowledge
Listen
Understand
ElicitLautrette NEJM 2007
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Dr. HibbertThe Expert Communicator
Plan the meeting
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Introductions&
Agenda
Swayden PEC 2012
Standing Sitting
1:28
Swayden PEC 2012
Standing Sitting
1:28
3:44
Swayden PEC 2012
Standing Sitting
1:28
3:44
1:04
Swayden PEC 2012
Standing Sitting
1:28
3:44
1:04
5:00
Swayden PEC 2012
Standing Sitting
image: nytimes.com
The Medical Bit
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Gather Understanding
The Medical Bit
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Fire a warning shot
The Medical Bit
image: nytimes.com
No Jargon
The Medical Bit
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Hear from everyone
The Medical Bit
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Use the “D-Word”
The Medical Bit
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Listen
The Medical Bit
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Make the patient’s voice heard
The Values Bit
Empathy [em-puh-thee]
noun
1. The intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.
2. The imaginative ascribing to an object, as a natural object or work of art, feelings or attitudes present in oneself.
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Make YOUR recommendation
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Reflect
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HerbThe son fromCalifornia
Molloy JAGS 1991
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HerbThe son fromCalifornia
Molloy JAGS 1991
Explore
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HerbThe son fromCalifornia
“I wish….”
Molloy JAGS 1991
Explore
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Rev. LovejoyPastoral Care
@expensivecare #smaccUS
@expensivecare
Is there a problem?
#smaccUS
@expensivecare
Is there a problem? Can communication be taught?
#smaccUS
@expensivecare
Is there a problem?
What do the experts do?
Can communication be taught?
#smaccUS
@expensivecare
Is there a problem?
What do the experts do?What about the
difficult situations?
Can communication be taught?
#smaccUS