Treatment protocols drive many cancer treatment regimens. To be a "good" patient or a "good" doctor, one may follow the directions for the next test or round of chemotherapy without stopping to evaluate the real cost or benefit to the patient. Some patients may need "permission" from their doctors or their families to take the time to weigh the benefits and burdens of their treatment. Building checkpoints into the schedule of visits gives patients permission to change the course of treatment, creating an expectation that periodic reevaluations are, in fact, part of what good patients and good doctors do.
Some patients, families, and physicians feel that they are "giving up" if they consider stopping a treatment course once it has begun, even if the treatment is doing more harm than the good that is expected (or hoped for). If checkpoints are set out in advance, they become part of the plan, not a "giving up" of the plan.
Checkpoints allow time and opportunity for patients and physicians to discuss alternatives to the painful (and inaccurate) "There's nothing more that I can do for you" conversations. Instead, treatments can be evaluated, overall goals revisited, and plans made to achieve those goals.
Checkpoints could be part of all chemotherapy and radiation therapy protocols. Improvement teams could document and review patient-provider discussions and any decisions that result. Leaders could offer feedback to clinicians regarding their compliance and adequacy of documentation.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].