Training Providers and Patients to Talk about End-of-Life Care

This will come as no surprise, but most doctors and patients do not want to talk about death and dying. But research is showing that failing to discuss transitions of care—from active cancer treatment to end-of-life care, can leave doctors unsure of what a patient truly wants at the end of his or her life. And failing to receive end-of-life care in line with their values and wishes can cause both patients and their families great distress.

An article recently published in Cancer said most doctors would not initiate discussions about end-of-life care options with terminally ill patients who still felt well. Instead they waited for symptoms or until there were no more cancer treatments to offer. Docs who did not feel confident in the realm of end-of-life discussions were less likely to initiate them, until the last minute.

Dr. Anthony Back, professor of medicine at the University of Washington, Seattle, developed the Oncotalk program to fill in an important element that he and his colleagues saw was missing in medical oncology fellows’ training: how to speak with empathy.

“Learning to communicate really requires a different kind of teaching, a different kind of teacher, and a different kind of learning experience than most of what is learned in medical school, which is a didactic, you-listen-to-the-experts kind of thing,” explained Dr. Back. “That’s not how you become a better communicator.”

Dr. Back and his colleagues teach Oncotalk in an intensive retreat format over the course of 4 days each year, covering issues in cancer communication from diagnosis to end of life: fundamental communication skills, giving bad news, managing transitions to palliative care when chemotherapy is failing, talking about advance care plans and do-not-resuscitate orders, discussing treatment options and informed consent, conducting a family conference, handling requests for therapies that a doctor feels are futile, and cultivating communication skills.

“I feel less flustered and my words are less tangled; I can focus on the person across from me and find out what they need from me in that moment,” wrote Dr. Lanie K. Francis in an article published in the Journal of Clinical Oncology after completing an Oncotalk retreat.

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