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