Conversation guide helps doctor tackle end-of-life care planning with patient

How does a doctor tackle the delicate issue of end-of-life care planning with a patient?

With an aging population and people living longer with chronic illness, it is increasingly important for patients and family members to decide how they and their loved ones would like to spend their final days. And for physicians in both hospital and primary care settings, it is crucial that they know how to address this issue with sensitivity.

A new "conversation guide" in Canadian Medical Association Journal (CMAJ) aims to guide physicians through these sensitive discussions with patients in hospital and their family members.

"Today health care is siloed and very fragmented," said guide author Dr. John You of McMaster University's Michael G. DeGroote School of Medicine. "The hospital-based physician almost never has a pre-existing relationship with a patient."

To help hospital-based doctors better understand patients' life stories, their concerns about dying and wishes for end-of-life care, he and colleagues created this conversation guide on behalf of the Canadian Researchers at the End of Life Network (CARENET).

"The hope is that this conversation guide will give front-line physicians a practical set of tools and information that will make them more comfortable in engaging patients and families, be comfortable with topics and guide them in identifying the patients most in need of engaging in conversation," said Dr. You.

Dr. You is an associate professor in the medical school's Departments of Medicine, and Clinical Epidemiology and Biostatistics.

He said this is important as more people are living longer with chronic conditions, the population is aging and end-of-life care is laden with technology.

Informed by the available evidence, the conversation guide provides practical advice in such areas as:

• identifying patients at high risk of dying
• how to communicate prognosis
• how to clarify patient values around their care plan
• involving substitute-decision makers in care planning
• documenting a patient's wishes.

Dr. You is currently analyzing information from a CIHR-funded study of hospital-based physicians and ward nurses at 13 Canadian hospitals, to understand what it is that prevents them from talking to patients about end-of-life care and dying.