Medical Tribune September 2008 SFVIII
David Brill
Delivering a terminal diagnosis and reviewing
a patient’s end-of-life options
can be demanding and often upsetting for
doctors, especially as most are not routinely
trained in these communication skills.
A new study shows, however, that
knowledge and confidence about end-of-life
discussions can be dramatically improved
by attending simple educational workshops
which involve practicing new skills in small
groups with support from instructors.
Doctors who took part also felt more at
ease talking to their colleagues about these
challenges, were more likely to plan for bad
news in advance and had improved intentions
of writing letters of condolence to bereaved
families in future.
The study’s senior author Professor Richard
Frankel said that many medical school
curricula, even in sub-specialties like medical
oncology, do not teach doctors how to
move from discussing cures to addressing
the issue of palliative care. As a result doctors
often have great difficulty with these
conversations and sometimes perceive the
patient’s condition as a failure on their part,
he said.
“This is an area where some cognitive
reframing is useful. Rather than thinking of
yourself as a failure because a patient’s life is
going to come to an end, thinking of this as
an opportunity to partner with patients right
up until the end produces some wonderful
results.
“A physician may go into it fearing that
they’ll get their own emotions involved and
stirred up, but I think that with some practice
and with some opportunities to practice
these difficult conversations can lead to extremely
meaningful patient partnerships
and really help patients to have the best end
of life that they can comfortably have,” said
Frankel.
The workshops were attended by 249
doctors, 103 of whom completed questionnaires
before and after. Statistically significant
changes were observed in measures of
knowledge, attitude change and professional
satisfaction.
The findings of the study were published
in The Journal of Psychosocial Oncology. [2008
26(3): 81-95]
Patients have a right to know their full
diagnosis and prognosis, and sharing this
knowledge appropriately can benefit all parties
involved, said Frankel, who is professor
of medicine and geriatrics at Indiana University
School of Medicine, US. He offered some
practical advice on how to approach these
subjects.
Doctors should prepare in advance by
asking their patients, at the stage of ordering
a diagnostic text, how they would like
any potentially upsetting findings to be
handled, he said. This avoids the situation
of having to speak into a “black box” with
no actual idea of what the patient’s preferences
are.
“Say something like: ‘everything is fine
right now, but if there were to be bad news at
some point, how would you like me to handle
it? Would you want to know everything,
would you want to know nothing, or would
you want to have a conversation to decide?’”
he said.
Frankel also advised using silence to allow
patients to process the news, rather than
simply marching on with more facts and figures.
“You’re potentially altering the entire
life of the patient in a very short period of
time and there’s only a limited amount that
people can retain when their entire lives are
transformed,” he said.
David Brill
Delivering a terminal diagnosis and reviewing
a patient’s end-of-life options
can be demanding and often upsetting for
doctors, especially as most are not routinely
trained in these communication skills.
A new study shows, however, that
knowledge and confidence about end-of-life
discussions can be dramatically improved
by attending simple educational workshops
which involve practicing new skills in small
groups with support from instructors.
Doctors who took part also felt more at
ease talking to their colleagues about these
challenges, were more likely to plan for bad
news in advance and had improved intentions
of writing letters of condolence to bereaved
families in future.
The study’s senior author Professor Richard
Frankel said that many medical school
curricula, even in sub-specialties like medical
oncology, do not teach doctors how to
move from discussing cures to addressing
the issue of palliative care. As a result doctors
often have great difficulty with these
conversations and sometimes perceive the
patient’s condition as a failure on their part,
he said.
“This is an area where some cognitive
reframing is useful. Rather than thinking of
yourself as a failure because a patient’s life is
going to come to an end, thinking of this as
an opportunity to partner with patients right
up until the end produces some wonderful
results.
“A physician may go into it fearing that
they’ll get their own emotions involved and
stirred up, but I think that with some practice
and with some opportunities to practice
these difficult conversations can lead to extremely
meaningful patient partnerships
and really help patients to have the best end
of life that they can comfortably have,” said
Frankel.
The workshops were attended by 249
doctors, 103 of whom completed questionnaires
before and after. Statistically significant
changes were observed in measures of
knowledge, attitude change and professional
satisfaction.
The findings of the study were published
in The Journal of Psychosocial Oncology. [2008
26(3): 81-95]
Patients have a right to know their full
diagnosis and prognosis, and sharing this
knowledge appropriately can benefit all parties
involved, said Frankel, who is professor
of medicine and geriatrics at Indiana University
School of Medicine, US. He offered some
practical advice on how to approach these
subjects.
Doctors should prepare in advance by
asking their patients, at the stage of ordering
a diagnostic text, how they would like
any potentially upsetting findings to be
handled, he said. This avoids the situation
of having to speak into a “black box” with
no actual idea of what the patient’s preferences
are.
“Say something like: ‘everything is fine
right now, but if there were to be bad news at
some point, how would you like me to handle
it? Would you want to know everything,
would you want to know nothing, or would
you want to have a conversation to decide?’”
he said.
Frankel also advised using silence to allow
patients to process the news, rather than
simply marching on with more facts and figures.
“You’re potentially altering the entire
life of the patient in a very short period of
time and there’s only a limited amount that
people can retain when their entire lives are
transformed,” he said.
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