End of Life Conversations are Hard

We stumble, we stutter, we say things that derail the discussion when we have a patient at the end of life. But how do we learn to do better? We model good behavior. But in order to do that we need to hear good discussions. I listened to Ashley Shreve's amazing SMACC Chicago talk:

SMACC Talk: What is a Good Death?

After listening, I wanted to bring Ashley back on to really get into the nitty-gritty of the semantics of End of Life discussions. Ashley has been on the EMCrit podcast before discussing Critical Care Palliation. Now lets hear from here again...

Tidbits I pulled out of the Podcast

* The three patients that will spur Ashley to try to have these discussions:

* 1. Advanced Cancer or Terminal Disease with Instability

* 2. Advanced Frailty/Dementia with Instability

* 3. Advanced Physiological Age (>85 y/o) with Instability

* Start with, "I'm so worried about your family member," and see the response

* Then, "Tell me how things have been going with your family member"

* Technique: Ask, Tell, Ask, Tell

* Know the trajectories of care for the diseases we deal with

* Does that mean you will do nothing? No, we actually want to intensify the treatment, with a focus on peace and dignity

* We don't want to artificially prolong the dying process

* Vitalists comprise 5-10% of the population, you are unlikely to convince these folks in the ED

* What if things don't get better?

Additional Resources

* Vital Talks Web Site

* Book: [easyazon_image align="right" height="75" identifier="0521706181" locale="US" src="http://emcrit.org/wp-content/uploads/2016/01/41VhxLk0IKL.SL75.jpg" tag="emcrit-20" width="50"][easyazon_link identifier="0521706181" locale="US" tag="emcrit-20"]Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope[/easyazon_link]

* Six ways to have End of Life Conversations with Compassion by Ashley

* Palliative Care FastFacts from Wisconsin

Now on to the Podcast...