End of Life Literacy

Patient had an incurable brain tumor with maybe 3 months to live, but the oncologist told him he should do chemo and radiation because a cure could be around the corner. The patient and his family asked me for my input on continuing treatment or switching to hospice, so I honestly told him my personal view. They thanked me profusely for my kindness, but mostly my honesty. They said too many physicians had sugar coated and given them vague responses to their questions.

Watching palliative care doctors have these discussions was illuminating. Rather than use phrases like “do you want us to do everything?” they ask “do you want to allow for a natural death?” which sounds better and is more true to what’s going on. They also start by asking what the patient wants, then includes the family in discussion, and constantly frame everything in the context of “this is what’s best for him/her because this is what he/she said she wants” instead of “this is what modern medicine CAN do.” I think everyone should have a chance to work with palliative care doctors to get their perspective on death and dying discussions.

I’ve had experiences where patients feel blindsided by “code status” talks. It’s so important the language we use in every encounter, especially so that we understand our patients’ and families’ wishes without coercing our own opinions onto them.