Have end-of-life conversations with patients ahead of time

Just as internists look ahead at the likely consequences of conditions such as hypertension or high cholesterol and talk with patients to make plans to prevent health problems, they can do the same for patients with life-limiting illnesses, says Janet L. Abrahm, M.D., in an interview with Medical Economics.

Internists can start those conversations with patients when they still have years left to live, says Abrahm, a palliative care doctor at the Dana-Farber Cancer Institute in Boston and professor of medicine at Harvard Medical School.

Discussions about end of life, however, can be difficult for physicians. While most doctors consider these conversations important, only 14 percent actually initiated such discussions, according to a recent survey.

Internists, however, often have conversations with patients about the goals of care, Abrahm says. "We rely on our internists to be the primary care physicians caring for a patient over a period of years. They are in the best position to understand clearly the patient's hopes and fears should they develop a serious disease or should they simply age," she says.

One way to identify patients who can benefit from a conversation is for a physician and staff to consider who they would not be surprised to hear has died in the next year, she says. That might be 10 or 20 patients to initially focus on. Physicians should have that conversation rather than learn a patient is intubated in the ICU and not know their wishes, she says.

To learn more:
- read the interview