Communicating With Dying Patients Within the Spectrum of Medical Care From Terminal Diagnosis to Death

Wenrich, Marjorie D.; Curtis, J. Randall; Shannon, Sarah E.; Carline, Jan D.; Ambrozy, Donna M.; Ramsey, Paul G.

doi:10.1001/archinte.161.6.868

Cited by 249 publications

(222 citation statements)

References 21 publications

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“…In several studies, both patients and family have been shown to consider clear information about what to expect during the dying phase as very important [21,22]. We found that, in the hospital setting, patients and family were indeed relatively often informed of the imminent death of the patient in the last 3 days of life.…”

Section: Discussionmentioning

confidence: 73%

The last 3 days of life in three different care settings in The Netherlands

Veerbeek

Zuylen

Swart³

et al. 2007

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Introduction Little is known about the characteristics of dying in different care settings, such as the hospital, the nursing home, or the home-care setting. Materials and methods We measured the burden of symptoms, medical and nursing interventions, and aspects of communication during the last 3 days of life within each of these settings. We included 239 of 321 patients (74%) who died in one of these settings in the southwest of The Netherlands, between November 2003 and February 2005. After the patient's death, a nurse filled in a questionnaire. Results Pain and shortness of breath were more severe in hospital patients as compared to nursing home and homecare patients, whereas incontinence was less severe in hospital patients. Several medical interventions, such as a syringe driver, vena punctures or lab tests, radiology or ECG, antibiotics, and drainage of body fluids were more often applied during the last 3 days of life to hospital patients than to nursing home and home-care patients. This also holds for the measurement of body temperature and blood pressure. In the hospital setting, the patient and the family were more often informed about the imminence of death of the patient than elsewhere. The general practitioner and other professional caregivers were less often informed about the imminence of death of hospital patients than of other patients. Discussion We conclude that pain and shortness of breath were more severe among hospital patients, whereas incontinence was more severe among nursing home and home-care patients. Hospital patients relatively often receive medical interventions and standard controls during the last 3 days of life. In hospital, communication about impending death seems to take place more often shortly before death.

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Section: Discussionmentioning

confidence: 73%

The last 3 days of life in three different care settings in The Netherlands

Veerbeek

Zuylen

Swart³

et al. 2007

Support Care Cancer

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“…Other research has shown that most patients want their oncologists to be willing to talk about death and dying [25,59] and cite emotional support as an important physician skill to help them cope when discussing the future [8]. Unfortunately, factors such as disease stage do not predict whether patients want to talk about end-of-life issues [41], so there is no reliable way to predict whether a given patient has concerns about death and dying.…”

Section: Discussionmentioning

confidence: 99%

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

Anderson

Alexander

Rodriguez

et al. 2007

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Objective-Cancer patients have high levels of distress, yet oncologists often do not recognize patients' concerns. We sought to describe how patients with advanced cancer verbally express negative emotion to their oncologists. Materials and methods-As part of the Studying Communication in Oncologist-PatientEncounters Trial, we audio-recorded 415 visits that 281 patients with advanced cancer made to their oncologists at three US cancer centers. Using qualitative methodology, we coded for verbal expressions of negative emotion, identified words patients used to express emotion, and categorized emotions by type and content.

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“…It may be helpful in these situations to acknowledge that discussions about dying can be difficult, but are nonetheless important for patients, families and physicians to undertake, and may provide an opportunity to decrease the burden of decision making on family members. It can also be useful to explicitly state that such a discussion will not diminish the physicians' focus on finding therapies to improve survival or quality of life, as some patients worry that such a discussion might cause a physician to ''give up'' on them [45]. Another useful tool for raising these discussions may be to frame them in the context of ''hoping for the best, while preparing for the worst'' [46].…”

Section: Overcoming the Barriers To Communication About End-of-life Cmentioning

confidence: 99%

Palliative and end-of-life care for patients with severe COPD

2007

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. For many patients, maximal therapy for COPD produces only modest or incomplete relief of disabling symptoms and these symptoms result in a significantly reduced quality of life.Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient-physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-oflife care more difficult. Consequently, patients and their families frequently do not understand that severe COPD is often a progressive and terminal illness.The purpose of the present review is to summarise recent research regarding palliative and end-of-life care for patients with COPD. Recent studies provide insight and guidance into ways to improve communication about end-of-life care and thereby improve the quality of palliative and end-of-life care the patients receive. Two areas that may influence the quality of care are also highlighted: 1) the role of anxiety and depression, common problems for patients with COPD; and 2) the importance of advance care planning.Improving communication represents an important opportunity for the improvement of the quality of palliative and end-of-life care received by these patients.

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Communicating With Dying Patients Within the Spectrum of Medical Care From Terminal Diagnosis to Death

Cited by 249 publications

References 21 publications

The last 3 days of life in three different care settings in The Netherlands

The last 3 days of life in three different care settings in The Netherlands

“What concerns me is…” Expression of emotion by advanced cancer patients during outpatient visits

Palliative and end-of-life care for patients with severe COPD

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