It can be a tough conversation for most doctors: talking to a patient who is dying.
It can make many physicians uncomfortable, which is why they can benefit from training to help teach them how to talk to patients about death and dying.
One of these efforts has been put together by Anna-Gene O’Neal, who runs Alive Hospice in Tennessee, according to STAT. She launched the SHARE simulation lab last year that allows physicians and other clinicians to run though scenarios with actors, who play the part of patients.
For instance, a doctor interacts with a “patient” who has lung cancer and has undergone chemotherapy. When he tells her she doesn’t need more chemotherapy, she wonders if she has beaten the disease, but the doctor must tell her the cancer has metastasized and she has only six months or less to live.
The simulation is recorded and the video given to the doctor as a way to learn how to deal with patient emotions that include confusion, denial, anger and grief. O’Neal watches the tape with the doctors on a big-screen TV and encourages direct and honest communication with patients. Clinicians pay $350 to work through four scenarios and then watch the videos and get feedback. She recommends doctors:
- Be aware of their body language. Look patients in the eye and focus on them.
- Communicate like it's a conversation. Become comfortable with long pauses after breaking difficult news to a patient.
- Be direct with patients about their prognosis.
Hospitals and hospice programs are setting up training programs across the country. Stanford’s palliative medicine department has used similar techniques to train hospice nurses in California, STAT said. Oncologists at the University of Rochester Medical Center in New York observe other doctors having conversations with patients facing terminal illness. And in Arizona, administrators of Hospice of the West in Phoenix hold regular training sessions at staff meetings.
The Florida Hospital Association has also partnered with the Institute for Healthcare Improvement to provide hospitals and communities with training designed to generate end-of-life care discussions early on, according to Hospitals & Health Networks. Hospital training began in May and community training will get underway as part of the Conversation Project, which aims to help patients die in circumstances and surroundings that they choose.
The statistics show that more doctors are engaging in end-of-life counseling sessions with Medicare patients. In 2016, the first year doctors could charge Medicare for the service, nearly 14,000 providers billed almost $35 million—including nearly $16 million paid by Medicare—or advance care planning conversations for about 223,000 patients from January through June, according to data released from the Centers for Medicare & Medicaid Services.