According to a recent study published in the JAMA Internal Medicine, scientists at McMaster University found that families who have difficulty accepting a poor prognosis can hinder the comfort care of their loved-one.
The study surveyed 1,200 doctors and nurses across Canada and found that talking about death before a crisis is key in helping to put the patients’ wishes and comfort first during an emotional time.
Difficulty can arise when families don’t fully understand the limitations and complications which may result from life-sustaining treatment. Families who disagree about choices for patients who may not have the capacity to make sound decisions, may consider aggressive options at the expense of the comfort of the patient.
Dr John You, the lead author of the study, reports that doctors need to become very “skilled and sensitive communicators”. He recommends the use of conversation guides to help support advanced care planning discussions with families before there is a crisis. Openly discussing preferences of care in life threatening situations, as well as addressing values, prognosis and concerns with patients and their families will result in better end-of-life care.
A report released at the end of last year from Health Quality Ontario, published the results of a national online survey that found nearly 55 per cent of Canadian adults had never discussed their end-of-life wishes with a family member, friend, doctor, lawyer or financial advisor. The report also revealed that 70 per cent of hospitalized elderly patients wanted comfort care rather than life-prolonging treatment. However, more than half of these patients were admitted to intensive care units.
End-of-Life care and open discussion will become increasingly important as the number of Canadians dying each year will increase by 40 percent over the next decade. Discussing death as a natural part of the life cycle, rather than a topic to be avoided, will ensure the best possible palliative care.