communication

… the second part of Billings’ article on family meetings in the ICU setting. “A key point: the clinical team ideally will make clear, strong recommendation to the family, based on the patient’s wishes, rather than asking family members what they want to have done.”

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The Word climbs up slowly out of the silence in the child, and the words of old men and women are slow, too, as they•return to the silence that is the end of life. Like a burden that has grown too heavy the word falls out of the mouth of the old, more down into […]

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… when their loved one is seriously ill … assure their loved one is receiving high quality care provide appropriate information adequate time to share perspectives and concerns accurate information about prognosis empathic communication and support trust anticipatory grief and bereavement   from Billing’s End of Life Family Meeting Part I: Indications, Outcomes, and Family Needs […]

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… cor ad cor loquitur … listen with your heart … pdf file outlines fundamental approach to communicating serious news …  slides • Start with the patient’s agenda • Track both the emotional and cognitive • Stay with the patient and move the conversation forward one step at a time • Articulate empathy explicitly • Talk about what you […]

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… don’t push (“righting reflex”) but reflect … Pollack et. al. discuss how to talk with patients and families when they are resistant to discussing the future or are ambivalent and unable to make a decision. Criteria to know if we have been successful … Letting patients talk as much as clinicians; Keeping question-asking to […]

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Gawande identifies core values for today’s physicians … “Which brings us to the third skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients. There is resistance, sometimes vehement resistance, to the efforts that […]

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… factors that influence decision makers’ perceptions of prognosis … Boyd et al sought to determine what sources of knowledge family members/decision makers use when determining the prognosis of their loved ones. “Less than 2% (3 of 179) of surrogates reported that their beliefs about the patients’ prognoses hinged exclusively on prognostic information provided to […]

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… higher costs in LA for the seriously ill related to 35% more hospital beds as well as more traditional hospice delivery model. Quality measures favored San Diego. Related editorial describes this medical torture. Related editorial in today’s NEJM.

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Do not go gentle into that good night, Old age should burn and rave at close of day; Rage, rage against the dying of the light. Though wise men at their end know dark is right, Because their words had forked no lightning they Do not go gentle into that good night. Good men, the […]

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… MacAuley’s excellent essay on “Patients who make ‘wrong’ choices” … ”Ironically, for all of palliative care’s talk of total suffering, we may be unwilling to accept that a patient’s emotional suffering over choosing a palliative course of treatment may be more severe than eventual projected physical suffering from an aggressive course … In the […]

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