How Technology Can Encourage End-of-life Talks & Reduce Risk

I recently came across discussion of a new end-of-life care study in the Journal of Clinical Oncology that I’d like to talk about today.

End-of-life care is tough, even on a good day. It seems to me that taking care of patients at the end of life and/or going into a field of medicine with a high mortality rate is a calling. It takes a special kind of person to take on that work. And, even if it is a calling, it is still tough to talk to patients specifically about their wishes for their end-of-life care. But, this new study shows that providing physicians with “electronic prompts” may encourage them to do so.

The study of 100 patients with lung cancer, and their oncologists, documented how many patients ended up with code statuses entered into their records after their physicians were prompted electronically (via e-mail) at the start of each new chemotherapy regimen. When compared to physicians who weren’t prompted, there was a significant increase in code statuses.

While establishing code statuses (and desires for end-of-life care) for patients is a good thing in itself, getting them early, as they did in this study, is really good. Because end-of-life conversations are difficult, many physicians avoid them, or put them off. Often, this results in a need to have conversations with patients or family members at very tense or urgent times of crisis, when a physician needs to know what to do (or not do) for the patient. Clearly, this is not the best time to have these conversations. This is one of those situations when a stitch-in-time-saves-nine and doing so can reduce your med mal risk.

To take time to thoughtfully and carefully discuss a patient’s wishes for the end-of-life, when neither the physician or patient is in crisis, is smart for everyone. First, it allows the physician to clearly explain the options available and the choices the patient has. Second, talking directly to the patient, while they are still able to carry on such a discussion, can go a long way towards a) building a caring and trusting relationship with the patient and b) taking the pressure off of family members who are already stressed at the thought of losing their loved one, by not having to force them to make a life-and-death decision at a time of crisis. And, third, it reduces a sense of chaos by firmly establishing that the patient’s wishes are being respected and that a plan is being followed in a controlled manner.

Thus, clearly establishing and documenting the patient’s end-of-life wishes ahead of time can reduce your risk –especially should a conflict arise between the patient’s well-established wishes and a family member.

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