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A conversation guide for doctors to help facilitate discussions about end-of-life care

patient_relative_hospitalMaintaining dignity and being in control of major decisions as their end of life approaches are top priorities for many patients. Despite these strong desires, many individuals and their families find it difficult to talk about how they and their loved ones want to spend their final days. But often physicians can help to initiate or facilitate these conversations.

To assist doctors in primary care and hospital settings in talking to patients and their families about such delicate issues, a group of Canadian physicians have published a conversation guide (subscription required) on the topic in the Canadian Medical Association Journal. Medscape reports:

The impetus behind these guidelines includes the aging population and longer life expectancy for people with chronic illness, necessitating informed decision-making and compassionate discussions regarding end-of-life care. To address these issues, the authors reviewed relevant evidence from targeted searches of MEDLINE through July 2012.

The guidelines address critical issues underlying such decision-making, including identifying patients at high risk for imminent death, communicating prognosis, determining patient values as they affect the care plan, involving surrogate decision makers in care planning, and documenting a patient's wishes.

Although the guidelines primarily target hospital physicians, the authors acknowledge that primary care clinicians should play a key role in advance directives planning. They also recommend initiatives to increase public awareness outside hospitals about the importance of advance end-of-life care planning and the limitations of life-sustaining technologies.

Among the recommendations to help educate patients and their families in making informed decisions are:

  • Identifying patients at high risk of dying
  • Communicating prognosis
  • Clarifying patient values around the care plan
  • Involving substitute-decision makers in care planning
  • Communicating a patient's wishes

Previously: Hospice by the Bay releases app to help physicians refer patients to end-of-life care, How a Stanford physician became a leading advocate for palliative care, The importance of patient/doctor end-of-life discussions and A Stanford nurse shares her experience in talking to her aging mother about end-of-life decisions
Photo by pudgeefeet

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