How can we encourage physicians to talk honestly with patients, families, and caregivers about Hospice and end of life decisions?

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TheresaBrownRN (Nurse (Verified) ) - 05 / 22 / 2012

This is a huge and hard question and I have no magic answer. There are docs who, no matter how you bring up the question of hospice or end of life planning, will never go down that road with the patient and absolutely will not want the nurse bringing up such questions, either. In these situations, if the hospital has an ethics committee they may be able to help. If palliative care has been consulted they also may be helpful. However, we’re all familiar with medically futile care and how emotionally difficult it is to be pulling out all the clinical stops for patients when there is nothing to suggest our care will in any way help them.

For doctors who are more open and able to discuss end of life planning, I keep the conversation focused on what the patient has said. If she says she is done with treatment I communicate that. If he says he just wants to go home and die, I pass that along, too. I encourage physicians to be as clear as possible and to be consistent. When a patient is very ill and several different services are looking after him, the patient often gets as many different reports of prognosis as there are physicians involved. Making the inpatient attending aware of everything the patient has been told by different doctors can at least help insure that that doc’s message is consistent.
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