The New England Journal of MedicineNavigating and Communicating about Serious Illness and End of Life

Understanding Patient and Physician Perspectives in the Complexities of End-of-Life Communication in Medicine

This article explores the challenging and nuanced area of communicating about serious illness and end-of-life care. It offers insights into the complexities that both patients and physicians face during this critical time, focusing on the integration of prognostic information and emotional support. The piece highlights the importance of an iterative, empathetic approach to conversations about prognosis and end-of-life planning, emphasizing the necessity for clinicians to be skilled in both conveying information and supporting patients through emotional and cognitive processing.

Key Points:

• Patient-Clinician Communication: Effective communication of prognostic information is essential, balancing honesty with empathy.
• Understanding Patient Hopes: Patients often oscillate between hopefulness and realism; acknowledging and exploring these hopes is crucial.
• Cognitive and Emotional Integration: Patients need help to cognitively and emotionally integrate their prognosis, which is a complex, evolving process.
• Advance Care Planning: The effectiveness of advance care planning varies; it should focus on understanding the patient’s values and preferences over time.
• Palliative Care Integration: Early palliative care shows positive outcomes in mood and quality of life, aiding patients in coping strategies and prognostic understanding.
• Clinician Skills Development: Clinicians need to develop skills beyond traditional communication methods, including understanding patient psychology and existential concerns.
• Prognostic Awareness: Building prognostic awareness in patients is key, involving an ongoing process of conversations and emotional support.
• Challenges in Communication: Misconceptions and emotional hurdles in patients are common; clinicians must be prepared to address these sensitively.
• Research Gaps: More research is needed in areas like patient-clinician communication dynamics, psychotherapy interventions, and documenting serious illness conversations in medical records.

According to the National Hospice and Palliative Care Organization (NHPCO), in 2020, 72% of hospice patients were able to die in the place they considered home, illustrating the effectiveness of hospice care in respecting patient end-of-life wishes.

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