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
Additional New Information
More on EMCrit
- Podcast 93 – Critical Care Palliation with Ashley Shreves(Opens in a new browser tab)
- EMCrit Podcast 25 – End of Life and Palliative Care in the ED(Opens in a new browser tab)
- EMCrit 285 – More on Palliative Care Conversations in Resuscitation(Opens in a new browser tab)
- EMCrit 276 – The Rapid Code Status Conversation with Kei Ouchi(Opens in a new browser tab)
Additional Resources
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GREAT talk Ashley! Your practicality regarding whether or not it is even worth initiating a conversation about this subject in an emergency setting (ie, your rapid “screening” techniques) — speaks wisdom beyond words. THANKS for presenting.