Tool for Talking about End-of-Life Care

Friday, May 20th, 2011
This post was written by Cheryl Miller

There’s no question that physicians’ primary role is to improve their patients’ survival.

But what about those patients whose options have run out?

A recent article on the lack of palliative care in HemOnc today reveals that patients who make a plan for end of life care experience less pain, fear and stress; death is less stressful on the family and costs are less overall. And physicians benefit significantly as well. According to a 2008 survey published in the Journal of Palliative Medicine, physicians who engaged in palliative care reported feeling greater satisfaction about the role they played with a dying patient and the patient’s family.

However, surveys show that training is still poor and physicians are uncomfortable discussing death and dying with their patients.

Part of the problem is that palliative care as a discipline only began appearing in medical school curricula in the past 15 years or so. Results from a national survey presented at the 2009 American Society of Clinical Oncology (ASCO) showed that:

    only 25 percent of respondents had completed a palliative care rotation

    42 percent of the respondents had not received explicit education about telling a patient he or she is dying

And a 2010 Journal of the American Medical Association (JAMA) survey revealed that:

    only 38 percent of National Cancer Institute designated centers had a palliative care fellowship program

    only 18 percent of the programs had five or more fellows.

What to do? The Hospice of Michigan has an innovative answer. They have developed a toolkit called Have You Had the Talk?™; it provides a thorough guide for decision-making related to end-of-life wishes, a central place to document medical history, organize physician contacts and legal documents, and tips for starting the conversation with loved ones. Among the contents of the toolkit are:

    A bright orange envelope to keep important medical information and related documents.

    A Ziploc bag to protect toolkit documents, including the Durable Power of Attorney. The large label has room to write key information on whom to contact in the event of an emergency.

    A large magnet for the freezer with room to write whom to contact in the event of an emergency and the location of important medical documents.

    A thin-tipped marker to fill out contact info on the magnet.

    A wallet card, which will help in the event of a medical emergency. It has a place to write contact information, physicians, and other important information.

    Simple-to-execute documents that you and your family will need in the event of an emergency.

It sounds like a good place to start.

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