Mastering Communication with Seriously Ill Patients

Back, Anthony L.; Arnold, Robert C.; Tulsky, James A.

doi:10.1017/cbo9780511576454

Cited by 189 publications

(149 citation statements)

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“…Seriously ill patients tend to value a surgeon who is capable of balancing honesty and open communication with hope and empathy. 30 A confident and compassionate surgeon must also strive to educate patients about their disease, as patients who are psychologically prepared for surgery tend to have better surgical outcomes. Meeting the patient's need for information regarding the surgical experience can also alleviate certain fears and misunderstandings about care.…”

Section: Discussionmentioning

confidence: 99%

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery

Hirpara¹,

Cleghorn²,

Sockalingam³

et al. 2016

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Background: Decisions leading up to surgery are fraught with uncertainty owing to trade-offs between treatment effectiveness and quality of life. Past studies on shared decision-making (SDM) have focused on the physician-patient encounter, with little emphasis on familial and cultural factors. The literature is scarce in surgical oncology, with few studies using qualitative interviews. Our objective was to explore the complexities of SDM within the setting of colorectal cancer (CRC) surgery. Methods:An interdisciplinary team developed a semistructured questionnaire. Telephone interviews were conducted with CRC patients in the practice of 1 surgical oncologist. Data saturation was achieved and a descriptive thematic analysis was performed. Results:We interviewed 20 patients before achieving data saturation. Three major themes emerged. First, family was considered as a crucial adjunct to the patientprovider dyad. Second, patients identified several facilitators to SDM, including a robust social support system and a competent surgical team. Although language was a perceived barrier, there was no difference in level of involvement in care between patients who spoke English fluently and those who did not. Finally, patients perceived a lack of choice and control in decision-making, thus challenging the very notion of SDM. Conclusion:Surgeons must learn to appreciate the role of family as a vital addition to the patient-provider dyad. Family engagement is crucial for CRC patients, particularly those undergoing surgical resection of late-stage disease. Surgeons must be aware of the uniqueness of decision-making in this context to empower patients and families.Contexte : Le choix de subir une chirurgie est toujours source d'incertitude en raison du fragile équilibre entre l'efficacité du traitement et la qualité de vie. Les études anté-rieures sur la prise de décision partagée se sont concentrées sur la relation médecin-patient; on a accordé peu d'importance aux facteurs familiaux et culturels qui entrent en jeu. En outre, la documentation scientifique ne foisonne pas d'études sur l'oncologie chirurgicale, et seules quelques données ont été recueillies au moyen d'entrevues qualitatives. Notre but était d'examiner les difficultés de la prise de déci-sion partagée dans le contexte d'une chirurgie pour un cancer colorectal.Méthodes : Une équipe interdisciplinaire a conçu un questionnaire semi-structuré au moyen duquel nous avons interviewé par téléphone des patients atteints d'un cancer colorectal et suivis par le même chirurgien oncologue. Nous avons atteint le seuil de saturation des données, puis réalisé une analyse thématique descriptive.Résultats : Pour atteindre la saturation, nous avons interrogé 20 patients. Trois thèmes principaux sont ressortis. D'abord, la famille était considérée comme un précieux ajout au tandem patient-médecin. Ensuite, les patients ont énuméré quelques éléments qui facilitent la prise de décision partagée, notamment la présence d'un bon réseau de soutien social et d'une équipe de professionne...

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Section: Discussionmentioning

confidence: 99%

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery

Hirpara¹,

Cleghorn²,

Sockalingam³

et al. 2016

cjs

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“…Concise statements that confirm the diagnosis should follow the warning shot: "Based on your symptoms and the testing we performed, you have ALS." The delivery should be empathetic and the wording clear; this includes active listening with open-ended questions, reflective statements such as "I wish things were different," 5 and empathetic responding (e.g., using the NURSE mnemonic 6 [table 1]). Time should be offered for patients and families to process the information before the physician inquires about how much additional information they would like to receive at that time.…”

Section: Discussing Serious Newsmentioning

confidence: 99%

Neurologists as primary palliative care providers

2016

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Purpose of review: To present current knowledge and recommendations regarding communication tasks and practice approaches for neurologists as they practice primary palliative care, including discussing serious news, managing symptoms, aligning treatment with patient preferences, introducing hospice/terminal care, and using the multiprofessional approach. Recent findings: Neurologists receive little formal palliative care training yet often need to discuss prognosis in serious illness, manage intractable symptoms in chronic progressive disease, and alleviate suffering for patients and their families. Because patients with neurologic disorders often have major cognitive impairment, physical impairment, or both, with an uncertain prognosis, their palliative care needs are particularly challenging and they remain largely uncharacterized and often unmanaged. Summary: We provide an overview of neuropalliative care as a fundamental skill set for all neurologists. Neurol Clin Pract 2016;6:40-48 P alliative care is specialized medical care for people with serious illness. With few curative options in neurology, most patients need to learn to live with their disease for a long time before they die with-or from-that disease. The newly proposed concept of distinguishing primary palliative care (skills that all clinicians should have) from specialist palliative care (palliative care specialty skills) 1,2 is particularly relevant to neurology, in which palliative and neurologic care needs coexist.In this review, we will follow 2 patients and their families through their illness trajectory (1 with amyotrophic lateral sclerosis (ALS) in the outpatient setting and 1 with severe stroke in the inpatient setting) and discuss proposed communication tasks. Rather than providing a comprehensive review of neuropalliative care, this article highlights some common issues faced by neurologists and aims to alert both neurologists and non-neurologists to the variety of palliative care issues in daily neurologic practice. For readers wanting a more in-depth and diseasespecific review of palliative care, we refer them to several recent reviews.

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“…Good communication can also help clarify patient/family factors. For example, promoting effective communication can prevent conflict in discussions of prognosis and end-of-life care [10]. Part of effective communication is to ensure that the patient and family have correct information about the disease prognosis and interventions.…”

Section: Is Situational Diagnosis Still Relevant?mentioning

confidence: 99%

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases

Ignatius

2017

AMA Journal of Ethics

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Lederberg MS. Disentangling ethical and psychological issues-a guide for oncologists. Acta Oncol. 1999;38(6):771-779. AbstractWe review Marguerite S. Lederberg's 1999 Acta Oncologica article entitled "Disentangling Ethical and Psychological Issues: A Guide for Oncologists," in which she introduces a method of analysis that facilitates clarification of ethical and psychological aspects of complex cases. Based on her understanding of the dynamics at play in patients', family members', and physicians' experiences, Lederberg formulated what she calls "situational diagnosis," a guide on how to distinguish ethical from psychological issues at the bedside or when an ethics consultation is requested. Here, we apply situational diagnosis to a case and consider whether and how Lederberg's guidance relates to current literature on how clinicians communicate with patients about serious illnesses.

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Mastering Communication with Seriously Ill Patients

Cited by 189 publications

References 0 publications

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery

Understanding the complexities of shared decision-making in cancer: a qualitative study of the perspectives of patients undergoing colorectal surgery

Neurologists as primary palliative care providers

How Situational Diagnosis Helps Disentangle Ethical and Psychological Features of Complex Cases

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