Palliative Care Conversations

This book will be the first of its kind to offer intensive conversation analysis on patient-clinician interactions in the context of palliative medicine. The book focuses on a series of individual case studies of conversations that revolve, in each case, around one key critical term that is often evoked or understood differently by clinicians and patients.

The story of the end-of-life experience of a palliative care physician who helped thousands of patients to die well. We all die. Most of us spend the majority of our lives ignoring this uncomfortable truth, but Dr. Larry Librach dedicated his life and his career to helping his patients navigate their final journey. Then, in April 2013, Larry was diagnosed with terminal pancreatic cancer. Unlike the majority of us, Larry knew the death he wanted. He wanted to die at home, surrounded by his family: his wife of forty years, his children, and his grandchildren. He did. He was peaceful and calm at the end. Larry proved that the “good death” isn’t a myth. It can be done, and he showed us how. Ever the teacher, Larry made his last journey a teachable moment on how to die the best death possible, even with a pernicious disease. As hard as it is to guide patients toward dying well, it is far harder to live those precepts day by day as the clock ticks down to one’s own death, but Larry, together with author Phil Dwyer, chronicled his final journey with courage and humour.

I spend my days explaining to people how they can expect to die. The Conversations of Palliative Care is a book related to decisions people have to make at end of life as well as those asked of them in the months or years leading up to then. It is a book designed to get people to begin to realize how their illnesses affect them and what the natural course of their illness is expected to be. A variety of topics related to this unique time in a person’s life is described as well as considerations for those who provide palliative care. Symptom management, staff angst, ethical issues, documentation, religious and social needs are addressed as well as specifics related to disease states, among other issues. The information is then personified through case studies: within a hospital, at a private residence, and a pediatric vignette. The purpose of this book is to raise awareness to end-of-life decisions patients are asked to make while increasing the comfort level of the medical staff who care for them. Ultimately, palliative care increases patient empowerment and knowledge about their bodies and unique set of medical diagnoses. Decisions they ultimately make regarding medical interventions are aligned to their person beliefs. These decisions are truly made in an educated manner. Utilized correctly, palliative care follows a person throughout the health care continuum. .

In this "enlightening" (Jane Brody, New York Times) book, Harvard Medical School physician Angelo E. Volandes offers a solution to traumatic end-of-life care: talking, medicine's oldest tool. There is an unspoken dark side of American medicine--keeping patients alive at any price. Two thirds of Americans die in healthcare institutions, tethered to machines and tubes at bankrupting costs, even though research shows that most prefer to die at home in comfort, surrounded by loved ones. Dr. Angelo E. Volandes believes that a life well lived deserves a good ending. Through the stories of seven patients and seven very different end-of-life experiences, he demonstrates that what people with a serious illness, who are approaching the end of their lives, need most is not new technologies but one simple thing: The Conversation. He argues for a radical re-envisioning of the patient-doctor relationship and offers ways for patients and their families to talk about this difficult issue to ensure that patients will be at the center and in charge of their medical care. It might be the most important conversation you ever have.

Physicians who care for patients with life-threatening illnesses face daunting communication challenges. Patients and family members can react to difficult news with sadness, distress, anger, or denial. This book defines the specific communication tasks involved in talking with patients with life-threatening illnesses and their families. Topics include delivering bad news, transition to palliative care, discussing goals of advance-care planning and do-not-resuscitate orders, existential and spiritual issues, family conferences, medical futility, and other conflicts at the end of life. Drs Anthony Back, Robert Arnold, and James Tulsky bring together empirical research as well as their own experience to provide a roadmap through difficult conversations about life-threatening issues. The book offers both a theoretical framework and practical conversational tools that the practising physician and clinician can use to improve communication skills, increase satisfaction, and protect themselves from burnout.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.