End of Life Conversations are Hard

We stumble, we stutter, we say things that derail the discussion when we have a patient at the end of life. But how do we learn to do better? We model good behavior. But in order to do that we need to hear good discussions. I listened to Ashley Shreve's amazing SMACC Chicago talk:

SMACC Talk: What is a Good Death?

After listening, I wanted to bring Ashley back on to really get into the nitty-gritty of the semantics of End of Life discussions. Ashley has been on the EMCrit podcast before discussing Critical Care Palliation. Now lets hear from here again…

Tidbits I pulled out of the Podcast

• The three patients that will spur Ashley to try to have these discussions:
  • 1. Advanced Cancer or Terminal Disease with Instability
  • 2. Advanced Frailty/Dementia with Instability
  • 3. Advanced Physiological Age (>85 y/o) with Instability
• Start with, “I'm so worried about your family member,” and see the response
• Then, “Tell me how things have been going with your family member”
• Technique: Ask, Tell, Ask, Tell
• Know the trajectories of care for the diseases we deal with
• Does that mean you will do nothing? No, we actually want to intensify the treatment, with a focus on peace and dignity
• We don't want to artificially prolong the dying process
• Vitalists comprise 5-10% of the population, you are unlikely to convince these folks in the ED
• What if things don't get better?

Additional Resources

• Vital Talks Web Site
• Book: Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope
• Six ways to have End of Life Conversations with Compassion by Ashley
• Palliative Care FastFacts from Wisconsin

Now on to the Podcast…

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Scott Weingart

An ED Intensivist from NY.

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