Sensitivity, Honesty at End of Life
Doctors have been urged to approach discussions about the end of a patient's life with sensitivity and honesty, in new guidelines published in a special supplement to the latest issue of the Medical Journal of Australia.
The new clinical practice guidelines for communicating prognosis and end-of-life issues were put together by a team from Australian and New Zealand of experts in palliative care, cancer, psychology, medical ethics, and geriatrics, among others.
Information at end-of-life consultations should be tailored to the individual needs of patients and their families, said committee chair Dr Josephine Clayton, Head of the Department of Palliative Care, Royal North Shore Hospital, Sydney, and a senior lecturer and research fellow at the University of Sydney.
"Be honest without being blunt or giving more detailed information than desired by the patient," the guidelines advise.
"Do not give misleading or false information to try to positively influence a patient's hope."
Preparation for the discussion is key, the guidelines state.
"Try to ensure privacy and uninterrupted time for discussion (and) negotiate who should be present during the discussion," they say.
"Show empathy, care and compassion during the entire consultation."
Key recommendations include:
- Offer to discuss what to expect, but give the patient the option not to discuss it
- Before giving new information clarify the patient's understanding of their situation and their preferences for information
- Consider the patient's cultural background
- Consider family caregivers' distinct needs for information
- Explain the limitations of prognostic and end-of-life information
- Acknowledge and respond to emotions and concerns
- Encourage questions and further discussion
- Keep a written record of discussions, and keep other health care providers informed
The Medical Journal of Australia is a publication of the Australian Medical Association.
The original article can be viewed online at www.mja.com.au