End-Of-Life Care

Aka: End-Of-Life Care, Discussing Death, Discussing Terminal Illness

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II. Management: Communication

  1. See Breaking Bad News
  2. Communicate prognosis
    1. Delay prognosis discussion until after accurate cancer staging
    2. Gauge how much information patient wants about the prognosis
    3. Discuss 5-10 year survival rates with and without treatment
    4. Communicate empathically without expressing false hope
  3. Review disease natural course with and without treatment
    1. Discuss treatment and potential adverse effects
    2. Discuss expected quality of life
    3. Address patient fears (e.g. suffering, abandonment)
    4. Three approaches
      1. Hope for the best and prepare for the worst (spectrum of possibilities) or
      2. Provide patient with information on full spectrum of treatment or
      3. Provide patient with sequential treatment options as events arise
  4. Discuss disease transition
    1. Goal: Extend life and improve quality of life (treatment and Palliative Care)
    2. Review Advance Directives (DNR, DNI, POLST)
    3. Discuss Palliative Care
      1. Cancer Symptom management (e.g. Cancer Pain Management, Dyspnea in Cancer)
  5. Discuss care coordination
    1. Parallel follow-up visits with both primary care and sub-specialists
    2. Communication among patient's medical providers

III. Management: Symptoms

  1. See Cancer Symptom for specific management

IV. References

  1. Long (2021) J Emerg Med 60(2): 175-91 [PubMed]
  2. Ngo-Metzger (2008) Am Fam Physician 77:167-74 [PubMed]
  3. Fallowfield (2004) Lancet 363:312-9 [PubMed]

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