It’s Time To Talk Honestly About Dying

Tree in Field
October 29, 2015 | Washington Post
by Karl Lorenz

Sometimes, it doesn’t take much to communicate well. One of my earliest experiences as a palliative care doctor was at the bedside of a man with advanced cancer who was having trouble eating and keeping up his weight. A feeding tube was planned for the next day, but it wasn’t going to help. Although no one had voiced it, we knew the cancer was getting worse. A gentle acknowledgement of that fact allowed us to recognize that death was near, and a moment of shared grieving gave us time to rethink the “more is better” refrain we’re so used to. He decided to forgo the tube for a chance to go home, where he died some weeks later.

Although language is one of our most fundamental faculties, we can’t be sure of clear communication when we are ill: What do we have? What’s likely to come next? What are our options? How much time is left? As it turns out, research shows that we often conspire with our doctors to suppress emotionally troubling conversations.

We also need to encourage more communication, of higher quality. Medicare recently proposed paying doctors for end-of-life planning, including the lengthy and repeated conversations that sometimes entails. One of the biggest oversights in end-of-life care is the need to ask patients or their families if they have had helpful end-of-life conversations. Health-care systems that do measure this tend to find significant gaps in quality, and the much larger Medicare system shouldn’t let doctors off the hook. Payment might help, but simply creating more advance directives won’t foster better end-of-life care unless we ensure good, high-quality discussions.

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