1. UNIT TWO: END OF LIFE ISSUES

2. Alvin H. Moss, M.D. The Need for More Physician Communication with Patients/ Families Facing the End of Life. West Virginia Medical Journal July/August 2001 Vol. 97, No. 4

3. What Patients and Families Want  Recognition of Importance of the Patient as a Person  Discussions of Important Decisions before they Occur

4. Robert Bruckman’s Approach in his book: How to Break Bad News

5. Getting Started  Enough Time  No Interruptions  Supporters Present

6. What Does the Patient Know?  Are they ready?  Is the right support available?

7. What Does the Patient Want to Know?  If this is serious, do you want to know?  Do you want the details?  Should I tell someone else?

8. Sharing the Information  Give a “warning shot,” then pause  Tell it (directly), then stop

9. Responding to Feelings  Be Prepared; Be Ready to Be Silent  Acknowledge Emotion  Expression, touch, offer water, tissue

10. Planning and Follow-Up  Assure care will continue  Safety and Support  Begin to Discuss Plan

11. Psychosocial and spiritual issues  Hospice care includes these  Uniqueness of experience  Identify issues critical to the patient

12. Potential Issues  Pain relief  Financial and Legal Affairs  Relationships  Spiritual Issues  Philosophical Issues

13. Some appear to sincerely want to fight death to the end; some welcome it as a friend.

14. Grief Models When is it abnormal? Predicting Bad Grief Outcomes.

15. On Death and Dying (Kubler-Ross) Not always quite as linear Skip stages; “ping-pong”

16. How long is normal? 6 weeks extreme distress 2-4 years maximum resolution

17. Risk for Poor Grief Outcomes Unexpected Death Unresolved Active Issues Financial Hardship/Forced Changes of Plans

18. Risk for Poor Grief Outcomes Psychiatric Illness Ilness not socially Acceptable Substance Abuse

19. How do we help? Be Available Help identify and validate feelings Reduce Inappropriate Guilt

20. How do we help?  Approve Time to Grieve  Refer if Necessary

21. How Do We help? We should be there for the patient and family. We should meet their needs, and only after that, our own. If we are not effective, we should refer. We must be careful of our own denial. This a critical part of healing.