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.