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Katie Duke on having end-of-life discussions with your patients

Nurses are well acquainted with the reality of death, and while it can be difficult to accept, every nurse learns, in his or her own way, how to cope on the job.

But that doesn’t mean it’s not a very real challenge for nurses to speak candidly (if at all) with patients and their loved ones about end-of-life care, which remains a delicate, even controversial topic.

In this week’s episode of “The Katie Duke Show” on ScrubsBeat, Katie explains why she thinks nurses are in a unique position to provide end-of-life counsel, and discusses how nurses should approach these discussions in a compassionate but direct manner to help patients and their loved ones make difficult decisions.

How do you think nurses should approach a conversation about end-of-life care? Share your thoughts with us in the comments section below.

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3 Responses to Katie Duke on having end-of-life discussions with your patients

  1. Samster

    Ever since my father passed from Pancreatic Cancer I have always spoken to my terminal patients about end of life care.

  2. tom combs

    Katie – Great thoughts. These discussions are so very important and so frequently lacking.
    No doubt they are difficult. Often I’ve heard physicians discuss end-of-life decisions with patients or family in strictly technical terms – any information that might seem to have personal judgement involved is studiously avoided – it’s as if the provider feels it inappropriate to share any opinion or information based in their knowledge and experience. If presented in such a fashion understanding is often missed and what sometimes results sounds like an awkward ordering exchange at a bizarre restaurant:
    “I don’t want the intubation but I will take chest compressions, and we want blood and shocks if their going to do okay”
    “Would you like pressors and what about surgery?”
    “Tell me about pressors – what are they again?”
    Excuse my whack attempt at humor but I’ll bet many of you have heard similar discussions.
    As an ER doc I had a lot of end-of-life decision discussions with patients and family – in time-pressed circumstances and with people who did not know me, or I them.
    Of course the clinical aspects of their condition must be explained in a fashion that provides them the best understanding possible. These discussions always involve considerable uncertainty – it’s good to acknowledge we don’t have all the answers. This is where judgment and experience can help families/patients.
    At that point what I felt comfortable with, and believe patients’ and their loved ones’ gained understanding from, was me putting things in personal terms. I’d share that if the patient was my brother/mother/father/spouse/other I would (or would not) subject them to intubation or CPR (or surgery, etc). That gives them an opinion based in knowledge, judgement, and personal experience – patients and their families are looking for that kind of input. I share that everything that we CAN do to patients is not always the same as what we SHOULD do for/to patients. The technical info is foreign and intimidating to people. I believe they get something from my sharing what I would do if it were me or my loved one. The decision is their’s but I truly believe such communication helps.
    Caring and informed nurses would seem to be excellent folks to have similar exchanges with their patients.
    (as an author I have a provider-family conversation in my novel that involving a brain-injured patient’s family and a major treatment decision – I do not want to take space here but if any are interested ‘personal message’ me and I’ll send it to you.)
    I think Katie is totally on target with this post. We can help patients and families much more than we have in the past. I believe all experienced providers know that sometimes hospice care or a procedure-free death is in the patient’s and family’s best interest – too often other decisions result from a lack of communication and understanding.
    Good Job, K. Thank you.

  3. Linda M

    As a hospice Nurse, I can tell you that MAYBE 25% of our pts come to us with EOL plans. So many don’t have DNR’s, or funeral home arrangements. It’s not uncommon for families to forbid us to discuss even the pts diagnosis, much less that I am the hospice nurse. I have had family members tell me they don’t want the pt to know they are terminal, so discussing POA, DNR or funeral homes are out of the question!

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