What Do Successful Conversations Sound Like?
Families may have had past conversations that sounded like “I want the doctors to do everything possible” or “I don’t want to be kept alive by artificial means.” Such general statements create a world of confusion for families and clinicians as illness progresses.
“I want doctors to do everything possible” might indicate a wish for tube-feeding, continuing blood draws and antibiotics, and intervening to dialyze a patient with kidney failure AFTER the physician has determined there are no curative treatments available. Would patients still choose these aggressive interventions – “everything possible” – if they reduced their quality of life?
Other people might consider “artificial means” to include treatments to reduce swelling, even though this could make a significant difference in alleviating the patient’s discomfort. Would a patient object to “artificial” interventions if they helped lessen suffering near the end of life?
These phrases – “artificial means” or “everything possible” – could mean something wildly different to patients and to their family. If patients are no longer able to articulate their wishes, the family may be left to wonder, “What does the patient want me to do?”
A guiding principle for end of life conversations is to focus on values, quality of life and a vision for how the patient will live out their life. To say “I would like to spend as much time as possible at home with family” may guide a patient and their decision-makers away from re-hospitalizations and ongoing interventions, and toward management of symptoms so that the patient’s time at home with family and friends is of the highest quality.
National Hospice and Palliative Care Organization (NHPCO) has produced valuable resources about planning ahead, caregiving and end of life care generally. These brochures offer useful tips on how to initiate conversations and ways to continue supporting discussions when family members disagree.
We especially recommend: Conversations before the Crisis, End-of-Life Caregiving, and Communicating End-of-Life Wishes. They are available for download at the Caring Connections Brochures.
If you identify with an Orthodox Jewish community, you might find these resources helpful:
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