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…

Podcast: Play in new window | Download (Duration: 42:47 — 39.3MB) | Embed

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Scott Weingart, MD FCCM

Editor-in-Chief, at EMCrit.org

An ED Intensivist from NY.
Professor
Chief, Division of Emergency Critical Care
Director, Resuscitation and Acute Critical Care Unit
Stony Brook Medicine
Stony Brook, NY, USA
No conflicts of interest (coi).

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