The American journal of geriatric cardiology
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Advance directives allow patients to have some control over decisions even when they are no longer able to make decisions themselves. All states authorize written advance directives, such as the appointment of a health care proxy, but commonly impose procedural requirements. Some states have restricted the use of oral advance directives, although they are frequently used in everyday practice. ⋯ Moreover, surrogates often cannot state patients' preferences accurately. Furthermore, discussions among physicians and patients about advance directives are flawed. Physicians can improve discussions about advance directives by asking the patient who should serve as proxy and by ascertaining the patient's values and general preferences before discussing specific clinical situations.
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Am J Geriatr Cardiol · Nov 2004
ReviewBreaking the "bad" news to patients and families: preparing to have the conversation about end-of-life and hospice care.
The ability to compassionately communicate difficult or "bad news" to a patient and family is essential to the provision of quality care at the end-of-life. Preparing to have these conversations requires a deliberate multilevel approach that includes: 1) becoming comfortable with end-of-life issues; 2) understanding the scope of the experiences from the patient's and family's perspectives; 3) understanding the full range of choices and options you can offer patients and families regarding their care (including hospice care); 4) developing a "can do" approach toward your involvement with end-of-life care; and 5) learning to effectively share and receive information in a compassionate manner. The following article explores this multilevel approach in an effort to assist physicians and other health care professions in supporting patients and families in their transition from curative care to hospice and palliative care.