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End-of-Life Decisions

  • Sydney Morss DyEmail author
Chapter
Part of the Cancer Drug Discovery and Development book series (CDD&D)

Abstract

Although end-of-life decision making is critical for good oncology care, physicians often do not initiate discussions until the last days of life and do not use good communication skills and evidence-based techniques. Research on deficits in decision making has found that patients often misunderstand information the first time it is provided or may not be ready to hear bad news, and that physicians often omit information about the terminal illness and options other than chemotherapy. Physicians also often fail to use basic communication techniques to elicit and improve understanding. Research supports the effectiveness of a variety of interventions to improve communication and decision making for outcomes such as reducing the use of interventions with a low likelihood of benefit, increasing hospice length of stay, and decreasing families’ symptoms of bereavement. The widely used autonomy paradigm of presenting patients with options such as chemotherapy and allowing them to choose may not work well near the end of life. An evidence-based approach based on planning over time, a systematic approach to communication, and eliciting goals and values satisfactory to all involved in the decision-making process may be more appropriate. Using history-taking skills to explore patients’ and families’ emotion-laden statements about end of life care, and using a differential diagnosis approach when decision making does not occur smoothly or when conflict exists, can also be helpful in challenging situations.

Keywords

End of life decisions Hospice Palliative care Communication Autonomy 

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Copyright information

© Humana Press, a part of Springer Science + Business Media, LLC 2009

Authors and Affiliations

  1. 1.Health Policy and ManagementOncology, and MedicineUSA

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