October 18, 2007 at O'Connor Hospital, San Jose
"We're Waiting for a Miracle": Tools for Difficult Discussions near the End of LifeA Workshop for Palliative Care Teams, Clergy, Chaplains, Nurses, Social Workers, and Physicians
Objectives:
-Know how to assess a patient's and family's readiness to engage in discussion of end-of-life care decisions.
-Choose and use effective interventions to help the hesitant to engage in these discussions.
-Promote goal-oriented and value-oriented conversations that will articulate hopes and clarify appropriate plans for care.
Featured speaker was Joseph Weiner, MD, PhD
Chief, Consultation Liaison Psychiatry
North Shore University Medical Center/Manhasset
Associate Professor of Clinical Psychiatry and Medicine
Albert Einstein College of Medicine
Manhasset, New York.
Dr Weiner's presentation examined the context of medical decision making near the end of life, outlining several disconnects that impair decision making, and opportunities for improved decision making:
Medical decisions are also social and emotional decisions influenced by relationships within a larger societal context. A "relational model" of decision making pays attention to the need to establish trust and the need to assess the patient's or family's readiness to confront mortality and make complex decisions.
The patient and family do not have to be ready for the death of the patient. To think otherwise risks iatrogenic harm.
Visualizing medical decisions as occurring through a process of growth and adaptation allows a relationship to flourish that is compassionate, satisfying and effective.
He then outlined a six step approach to facilitate decision making near the end of life:
Develop Trust
Assess and Facilitate Readiness
Illustrate Decisions with Life Example
Link Current Decisions with Life Example
Offer Medical Opinion
Negotiate
His presentation was followed by a panel discussion Q and A to discuss application of these models in care where chaplaincy and palliative care overlap.
The conference included 4 hours continuing education units for physicians, nurses, or social workers.