Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part A Communication Issues
Chapter 2. Beyond Advance Directives: Importance of Communication Skills for Care at the End of Life
James A. Tulsky, MD
Affect
Topics Discussed:
advance directives, communication, incorporating patient values and preferences, supportive communication, trust and distrust
Excerpt:
"Although Mr N's physicians talked to him and his family
on multiple occasions about his illness, the likely prognosis, and
options for care, ultimately the patient's decisions contributed
to a tragic outcome. Factors in addition to words influence how
the messages of a medical encounter are interpreted and can complicate
a seemingly straightforward transaction.Trust, the confidence that a clinician is acting unfailingly
in the patient's interest, is fundamental to effective
medical care, particularly at the end of life. Ms N ascribed unprofessional
motives to the physicians' actions, a belief that may have
provoked her extraordinary response to the resuscitation attempt.
Although conflict among health care professionals, patients, and
families is not uncommon,32 the establishment of
trust fosters successful resolution of conflict through open and
honest communication.2,20,32,33..."
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