End Of Life Decisions

Patients may not address “end-of-life issues” because of stress and anxiety. In my experience, I have found that patients are often under more stress and anxiety when discussions about prognosis and goals of care have not occurred. People approach a cancer diagnosis and treatment differently, influenced by their personalities, life experiences, education as well as personal and spiritual beliefs. It is important to first understand how a patient is coping with and understanding their illness and prognosis. Stress and anxiety often arise from misunderstanding and/or fear about the underlying illness. If this is the case, starting a dialogue with the patient, to clarify misconceptions and openly address patient and family fears, will help to dissipate stress and anxiety and allow an open discourse about prognosis and patient wishes for care at the end of life.

It is very common for a family to be faced with making difficult decisions about end of life care. The palliative care service can be helpful in this situation. Palliative care services are experts at being sure the right medications are being used to provide comfort and awareness, coordinating family meetings, and discussing prognosis. They can also assist in weighing the benefits or risks of a life supporting therapy such as going on a ventilator or dialysis. Having an advanced directive that designates a surrogate decision maker is important but many do not have one when a crisis occurs.