Ask The Expert: How Do You Handle End-of-Life Care in a Patient Who Does Not Know They Are Dying?

2017-10-23T21:32:44+00:00 May 1st, 2017|

By Dr. Jessica Nutik Zitter

Source: Practical Pain Management

Unfortunately, many patients with a terminal illness who are referred for procedural or medical treatment of refractory pain will not be aware that they are dying. There is a common resistance among physicians to communicate bad news, particularly with regard to impending death.1 In my book, Extreme Measures: Finding a Better Path to the End of Life, I write about a patient with end-stage lung cancer named Marcia Green.She had no idea she was dying when I first met her, despite abundant evidence to the contrary. There are many reasons that clinicians avoid these conversations, including lack of training, time constraints, and a culture that values continued treatment and life-prolonging interventions above considerations concerning quality-of-life decisions.3

In the absence of shared knowledge of this critical information with the patient, there is a tendency for the patient to get shuttled onto what I have come to call the “end-of-life conveyor belt.” When an incurable condition is not acknowledged, patients may be submitted to end-of-life medical care where they are given increasing levels of life-prolonging technology and medications. Ample data support a clear reluctance, even opposition, to this kind of harsh treatment.4

While this may seem obvious, patients cannot carefully and comfortably plan for a good death if they don’t know that they’re dying. (…) Read Full Article Here

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