Title: Fast Fact and Concept #65: The Living Well Interview
Author(s): Bruce Ambuel, PhD
"When a person faces a fatal disease that is likely incurable, he or she faces specific decisions not only about medical treatment but also about broader, existential issues concerning the best way in which to spend his or her remaining time." (Hammes, Bottner et al. 1998)
Doctor-patient discussions about end-of-life treatment are often framed as a choice between "medical treatment vs. treatment withdrawal." When framed in this manner, treatment withdrawal is a negative choice that often implies giving up, abandonment, not giving the doctor a chance to do his or her job, and not caring; this option would seem to be no option at all.
Bernard Hammes, PhD, suggests that the physician can reframe the doctor-patient dialogue about end-of-life treatment by starting a conversation with the patient focused on the question "How can we help you live well?" The goal of the living well interview is to elicit the patient's perspective regarding how they want to spend their remaining time. Treatment decisions are then discussed within this broader context of patient goals and hopes. Treatments become tools for achieving patient goals.
The Living Well Discussion
When: Begin soon after the diagnosis of a life-limiting condition.
Who: Physician and patient with support from others: hospice nurse, chaplain, family, etc.
How: Begin by expressing a need and interest to understand the patient's views. The physician's initial goal is to develop a broad understanding of the patient's hopes and goals, not to develop a specific medical plan. Specific treatment decisions are made after the patient and health care team have developed an understanding of the patient's broader goals.
What to say: "Given what we now know about your medical condition..."
References Hammes, B. J., W. Bottner, et al. "Expanding frames... opening choices: reconsidering conversations about medical care when cure is not possible." Ilness, Crisis & Loss 1998; 6(4): 352-356. Hammes, B. J. and B. L. Rooney. "Death and end-of-life planning in one midwestern community." Archives of Internal Medicine 1998; 158: 383-390.
Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #65 The Living Well Interview. Ambuel, B. April, 2002. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339-340.
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Creation Date: 4/2002
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
|Non-Physician: Clergy/Chaplains, General Public, Graduate Students, Lawyers, Patients/Families, Nurses, Social Workers|
ACGME Competencies: Interpersonal and Communication Skills, Patient Care
Keyword(s): Advance directives, Cross-cultural care, Negotiating treatment goals, Prognosis, Treatment withdrawal, Treatment withholding
The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).