X-Message-Number: 26928
Date: Sun, 4 Sep 2005 13:11:05 +0200
From: Eugen Leitl <>

Subject: [: [ccm-l] When and How to Initiate Discussion About
Prognosis and End-of-Life Issues with Terminally Ill Patients]

--uOOcqLQ8l/YzXNYx
Content-Disposition: inline

----- Forwarded message from Eric Hodgson <> -----

From: Eric Hodgson <>
Date: Sun, 04 Sep 2005 02:08:00 +0200
To: 
Subject: [ccm-l] When and How to Initiate Discussion About Prognosis and
	End-of-Life Issues with Terminally Ill Patients 
X-mailer: Pegasus Mail for Windows (4.21c)
Reply-To: 

When and How to Initiate Discussion About Prognosis and End-of-Life 
Issues with Terminally Ill Patients 

Josephine M. Clayton MBBS(hons), FRACP, FAChPM, Phyllis N. Butow 
Mclin Psych, MPH, PhD and Martin H.N. Tattersall MB BChir, MSc, 
FRACP, MD 

Medical Psychology Research Unit (J.M.C., P.N.B., M.H.N.T.), School 
of Psychology and Faculty of Medicine, University of Sydney; and 
Sacred Heart Palliative Care Service (J.M.C.), St. Vincent's 
Hospital, Sydney, New South Wales, Australia 

Accepted 23 February 2005.  Available online 24 August 2005. 




Abstract
The aim of this study was to explore by whom, how, and when 
discussions about prognosis and end-of-life issues should be 
initiated with terminally ill patients, and the context in which 
these issues can be optimally discussed. Focus groups and individual 
interviews were conducted with 19 palliative care (PC) patients, 24 
carers, and 22 PC health professionals (HPs). Participants had 
disparate views regarding by whom and when such discussions should be 
initiated, although a similar range of perspectives was expressed by 
all participant groups. Four main approaches were identified: wait 
for the patient/carer to raise the topic; HPs to offer all PC 
patients and their carers the opportunity to discuss the future 
(preferred by the majority of participants); HPs to initiate the 
discussion when the patient/family need to know; or HPs to initiate 
the discussion when the patient/family seem ready. Four themes 
emerged regarding the optimal context of the discussion: importance 
of the relationship with HP, clarifying the patient/carers' 
understanding and how much detail they want to know, negotiating who 
should be present during the discussion, and who should deliver the 
information. Initiating prognostic discussions with terminally ill 
patients requires considerable skill and sensitivity. Communication 
skills training for HPs may be required to optimize such discussions. 


Key Words: Terminally ill; palliative care; communication; prognosis; 
end-of-life issues 


----- End forwarded message -----
-- 
Eugen* Leitl <a href="http://leitl.org">leitl</a>
______________________________________________________________
ICBM: 48.07100, 11.36820            http://www.leitl.org
8B29F6BE: 099D 78BA 2FD3 B014 B08A  7779 75B0 2443 8B29 F6BE

--uOOcqLQ8l/YzXNYx
Content-Description: Digital signature
Content-Disposition: inline

-----BEGIN PGP SIGNATURE-----
Version: GnuPG v1.4.1 (GNU/Linux)

iD8DBQFDGtZJdbAkQ4sp9r4RAsPMAKCa6XzKSxlO+0t0Fb/YMoSTZD/nWACgsWNR
RBXvEkSZZAMf2ECi8nicWp8b/B
-----END PGP SIGNATURE-----

--uOOcqLQ8l/YzXNYx--

Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=26928