How to Have Difficult Discussions About Palliative Care - PRIMARY

How to Have Difficult Discussions About Palliative Care

Senior patients depend on their doctors to administer effective treatments when they suffer from severe illnesses or diseases. Unfortunately, these are often aggressive treatments that have uncomfortable side effects. Worst of all, the treatments don’t end up eliminating the illness. In fact, they could end up having the reverse effect by making the symptoms worse rather than better.

A good primary care physician should have an honest discussion with their patient about alternative care that is less aggressive. No primary care physician likes to have this conversation with patients because it feels like the doctor is no longer trying to cure the problem. That could make a patient feel hopeless about their situation.

It is difficult for patients to accept that their illness might not disappear. So, what the doctor will do is suggest palliative care to reduce the symptoms and make the patient feel better while living with the illness. But no matter how experienced you may be as a doctor, there is no easy way to approach this conversation with a patient.

Below are some tips on how to handle a difficult discussion about palliative care with your patient.

1) Warn the Patient Before the Conversation Takes Place 

When you schedule an appointment for your patient to talk to you, it is best to give them a general warning ahead of time about how you will want to discuss palliative care with them. That way, they can mentally prepare themselves for the discussion before attending their appointment with you.

Sometimes a patient may want family members to attend the discussions in order to receive moral support. Videoconferencing makes this process easy because you can invite multiple people from different locations to join the same discussion via Zoom or other videoconferencing software.

2) Describe Palliative Care as a Normal Next Step in Treatment 

Part of a doctor’s job is to educate their patients about their illness and the steps needed to deliver proper care from this point forward. When you bring up the topic of palliative care in the discussion, your patient may think it means death is approaching them.

As their doctor, it is your job to explain that palliative care doesn’t necessarily mean the patient will die. Instead, it just means that it is the next normal step in treating their particular illness.

3) Explain That Palliative Care is Not the Same as Hospice Care 

People often use the terms “palliative care” and “hospice care” synonymously. However, patients need to understand the difference between these two types of care.

Hospice care is used as a last resort if a patient elects to stop using traditional curative treatments for their disease because they are no longer effective. Hospice is a way to make a patient feel more comfortable as they struggle with the symptoms of their disease.

Palliative care is different because the patient doesn’t necessarily need to stop using curative treatments. Instead, the patient can receive both curative treatment and palliative care simultaneously. Palliative care can make patients feel more comfortable as they undergo intensive and exhausting treatments, such as chemotherapy.

4) Spend As Much Time As Needed with a Patient

 So many primary care physicians today spend a few minutes with their patients and then send them out the door. Hopefully, you won’t do the same thing when talking to your patient about palliative care.

This particular topic requires a reasonable amount of time for discussion and the opportunity to answer questions about it. You’ll want the patient to walk away with a clear understanding of palliative care and how it can benefit them.

5) Show Empathy 

Never tell a patient that nothing can be done to treat their disease. As their primary care physician, keep making treatment suggestions to help them manage their pain and provide them with social support. You don’t have to make any guarantees about the future. Just show them how they can get help in dealing with their condition.

6) Never Give a Life Expectancy Prognosis 

A patient suffering from a deadly disease will probably want to know how much time they have left to live. It would be impossible for a doctor to make this prognosis because everyone’s body reacts differently to diseases. Some patients may live longer than others when suffering from the same conditions, so there is no way to know for sure.

Inform your patient about what they will likely experience from having the disease, but don’t give them a death prediction. If they insist on knowing, provide them with a broad estimate of the number of weeks, months, or years they have left to live.

7) Consult with Another Doctor 

Don’t be afraid to ask for advice from another primary care physician specializing in palliative care. Sometimes it helps to get feedback and advice from your peers about the best ways to approach palliative care conversations with patients. Since your peers have more experience in this matter, they are the best equipped to help you improve your discussion skills on this topic going forward.

Learn More 

Primary Medical Care Center has a team of palliative care specialists available to help guide other doctors in these discussions with patients. Contact our doctors at (305) 751-1500 for more information.