Palliative care physician Paige Patterson shared her five ways to have a serious conversation:
1. Communicate with the whole person.
2. Use a guide to ask about the hard stuff.
3. When you’re stuck in a conversation, “drop the rope.”
4. Stay resilient in the face of tough emotion.
5. Compassion goes both ways.
rom a patient’s perspective, what counts as good care depends on the values and priorities of the individual. When medicine doesn't address palliative care issues, it often results in patients getting care they don't really want that may even be harmful to them. Palliative care is for people at any stage of a serious illness. It’s not just for patients facing a terminal diagnosis, it’s also for illnesses such as chronic obstructive pulmonary disease (COPD), kidney disease, and neurological illness like Alzheimer’s.
As palliative care clinicians, we work to address physical needs and emotional needs. We treat the whole person and their family.
Specially trained for hard conversations
For patients, being heard and understanding the options to build a personalized care plan—on their own terms—creates value. And while all patients deserve these basic necessities, it’s acutely important we get it right with patients facing serious health challenges.
Palliative care clinicians are specifically trained for this type of care. They also have the time to both address a patient’s physical and emotional needs while also caring for the family.
By taking the time to know what is most important to the patient, clinicians can give options to help patients understand the potential trade-offs that may be involved. For example, an aggressive treatment may provide additional months of life, but with diminished quality of life due to the treatment side effects. It is a trade-off decision only the patient, based on her unique perspective and a realistic understanding of the options, should make.
The pain of prognosis–palliative care can help
That conversation requires talking about prognosis, which is a sensitive and emotionally draining topic. Not all clinicians feel comfortable talking about these things. Sometimes it feels easier to discharge the patient and hope for the best, or do the procedure because it might help. It’s a short-term but much easier approach for clinicians, and it's initially easier for patients, too. Unfortunately, there are severe consequences when we fail to have honest, realistic, and compassionate conversations about the most important issues patients face. Palliative care can help.
The Value Equation of Palliative Care
Palliative care is better for patients and better for our system. Palliative care delivers a better quality of life that meets patient goals and uses resources appropriately.
Palliative care improves quality: Research suggests that certain patients with heart failure and lung cancer may live longer with palliative care.
Conversations help with costs: Outlining care options—with clear and honest prognosis details—is respectful and helps patients make better decisions. For example, an additional chemotherapy treatment or a burdensome surgery might be unwanted by a patient who is presented with clear feedback about expected outcomes and quality of life.
Information reduces anxiety and stress: Palliative care helps families come to terms with a prognosis while honoring the patient’s voice. Clinicians often worry that understanding prognosis may cause patients to become depressed or lose hope. On the contrary, sitting down as a family to discuss the care the patient wants can eliminate confusion and stress. A conversation to outline a loved one’s final wishes may put family members at ease and help deter unnecessary misunderstandings.
Nate Wanner
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