Balance Hope with Reality in End of Life Decisions
Part 3 in a series on Breaking Bad News to Patients
You’re a physician communicating treatment options with a terminally ill patient and family. Of course, it’s in the best interest of the patient to offer hope and encouragement when discussing treatment.
But it’s also critical to not give hope more prevalence over reality in your communications. When reality is overshadowed–there’s a possibility that the patient and family may ultimately end up confused, or regreting their decision to undergo aggressive treatment.
I coached clinicians in the art of breaking bad news to patients in large group practices and hospitals. But it wasn’t until my own experience witnessing my late husband’s battle with pancreatic cancer that I learned a critical truth:
A physician’s communication is ideal when there’s a healthy blend of reality and hope. This balance helps the patient throughout the decision making process, especially when the going gets tough.
My late husband, Jeff, was way too young to die, and was provided with a 3-6 month life expectancy if he didn’t opt for aggressive treatment. There was no question over opting for the prescribed regimen. Throughout it all, the oncologist had the greatest upbeat personality, encouraging Jeff to try different therapies and new, experimental medicines.
But he also failed to communicate the lasting and painful side effects and consequences of the treatment regimen. I was aware of what would happen. What was I to do…stifle my husband’s hope? Don’t think so.
After four months, I was concerned and unhappy over the doctor’s management of the communication: I would have preferred a stronger dose of reality than hope. Treatment because close to draconian in so many ways, affecting Jeff’s pain levels, his nutrition, emotional health, ultimately provoking an uncompromising depression and anxiety in his everyday experiences.
Jeff’s quality of life wasn’t acceptable.
I believe that one common trait that all terminal patients carry in their hearts and souls is hope. Hope is why they get up in the morning and accept chemotherapy, radiation therapy, etc. Hope moves them to go through regimens–often experimental and drastic–that can be painful for the family member to witness, carrying unforgettable memories lasting long after a loved one’s death.
How can physicians help to create a balance of hope with reality?
- Ensure that the patient and his family (or loved ones) are alerted or fully understand the consequences of treatment, the side effects, the risks, and the quality of life issues. The more information that is realistically provided, the better it is for the patient to be in control over treatment decisions.
- Don’t vacillate from bringing up the incredibly difficult discussion that maybe more treatment isn’t the best option for the patient’s quality of life. Being honest is critical.
- If needed, or if you sense that there’s conflicting feelings going on between the terminally ill patient and his loved one; ask to speak to the family member privately, so that you may glean their feelings about treatment decisions.
- Always allow a forum for the patient and his loved one to ask questions or be totally updated. And always communicate to the patient and family–that it’s imperative to balance hope with reality when making end of life decisions.