How to start a conversation about end-of-life

"I'm worried about you." When physicians have to begin a conversation with a patient they believe may die soon, that's one way to start, Thomas J. Smith, M.D., professor of oncology and director of palliative care for Johns Hopkins Medicine in Baltimore, told Medical Economics.

In the book, "Being Mortal: Medicine and What Matters in the End," author Atul Gawande, M.D., describes saying this sentence to an advanced cancer patient: "They were such simple words, but it wasn't hard to sense how much they communicated," he wrote. "I had given her the facts. But by including the fact that I was worried, I'd not only told her about the seriousness of the situation, I'd told her I was on her side--I was pulling for her."

Historically, conversations such as the one Gawande described with his patient have taken place in the hospital setting--and so too was the availability of palliative care. But outpatient palliative care--which aims to relieve symptoms and improve quality of life without forcing patients to give up curative treatment--has grown in recent years with positive results, according to Medical Economics.

After Duke University Health System started an outpatient palliative clinic for cancer patients in 2012, for example, it opened a second clinic for patients with other conditions two years later in response to physician lobbying, said Anthony Galanos, M.D., director of inpatient palliative care at Duke University Hospital.

"All of these folks had patients who had terrible symptoms that needed management," Galanos said, "as well as patients who had a lot of questions and needed help with navigating goals of care."

To better identify patients who may be candidates for palliative care, doctors should learn more about the stages of advanced disease, so they can better estimate a patient's life expectancy, said Daniel Hoefer, M.D., chief medical officer for outpatient palliative care and hospice at San-Diego based Sharp HealthCare.

To learn more:
- read the article