The NuHealth System hosted its second annual ethics conference April 26 at the Nassau University Medical Center in East Meadow, N.Y. The focus of this years conference, entitled “Starting the Conversation,” was end-of-life issues, such as how to approach patients about their care.
In his welcome address, NUMC medical director Steven Walerstein, MD, explained the dire need for conferences that approach this sensitive subject.
“As I make rounds, nurses often come to me with frustrations about communication between patient, families and ICU staff regarding end-of-life care,” he said. “Its not the decision, its the discussion, that matters most.”
Daniel Cogan, RN, NP, director of palliative care at NUMC, a NuHealth facility, presented on how to effectively communicate with patients and families. Referencing a study featured in the Journal of the American Medical Associations Internal Medicine April publication, Cogan demonstrated how few patients wishes are known to healthcare providers.
The study reported that of 278 elderly patients at high risk of dying within 6 months, 92% of those patients had discussed their wishes with family, but only 30% had discussed those same wishes with their physicians.
To have a succesful dialogue about end-of-life care, Cogan said the discussion needs to happen with honesty, beneficence, autonomy and justice, along with common sense and respect for patients and families.
“Just talking about it is not enough,” he said. “We need to talk about it with skill and sensitivity.”
According to Cogan, the goals of advance care planning should include ensuring that clinical care is consistent with patient preferences when capacity is lost; improving decision-making processes; improving the patients well-being by reducing the frequency of overtreatment or undertreatement; and reducing patients concerns about possible burdens placed on family and others.
Cogans tips for effective end-of-life conversations included actively listening to the patient and then adopting the patients language regarding the illness and concerns or fears; giving honest infomation using affirmative prompts, not questions; understanding the family dynamics; never asking, “What dont you want us to do?” and instead offering medically appropriate professional recommendations.
“Just 40 seconds of empathetic language is all it takes,” Cogan said. “You do have time.”
Ideally, Cogan noted, the discussion should take place well before entering palliative care.
“The discussion should begin in the primary physicians office,” Cogan said. “The farther upstream, the better.”
The conference also included a keynote presentation by Patricia Bomba, MD, about the Medical Orders for Life-Sustaining Treatment program, known as MOLST; a panel discussion on how different religions approach end-of-life care; and a student and resident conversation-practice session.
— Tracey Boyd is a regional reporter.