What Helps Create the Best End Of Life Plan?

When facing the end of life, patients and their families must make difficult decisions about continuing curative treatments or moving to pain management and comfort care.

Futurity’s recent article entitled “Communication is Key to Guide Patients to Best End-Of-Life Plan” explains that using six months of observational data from a hospital in a Midwestern town, researchers found many providers did not dismiss their patients’ emotions or tell patients to feel differently. Instead, they validated their patients’ fear, hope, or guilt and then walked them through the likely results of continuing treatments.

The researchers found this approach led patients to comply with the providers’ suggestions for end of life or palliative care nearly three-fourths (73%) of the time. The compliance rate was 43% when providers did not use this style of communication.

“These efforts are not aimed at changing the patients’ emotions; they’re aimed at changing their expectations,” says Clayton Thomas, assistant professor of teaching, management, and entrepreneurship, at Iowa State University and co-author of the paper in Organization Studies.

In the paper, Thomas and his co-author Shibashis Mukherjee, assistant professor of management and organization at Ahmedabad University in India, included a discussion between a senior and a member of the care team to emphasize what they termed “feeling rule management.”

The patient faced a decision on whether to sign a “do not resuscitate” (DNR) order if the patient’s heart stopped beating. After the care provider explained that cardio-pulmonary resuscitation (CPR) would likely break the patient’s ribs, causing a slow and painful recovery during the patient’s final days of life, the patient chose to sign the DNR order.

“People often think they should fear death. They may not realize that they should fear the cure, that the treatment to prolong life could cause more suffering or lead to other health problems during a patient’s final days,” Thomas says.

Another example of end of life care that could mean more health complications is intubation, which creates an artificial airway for patients who cannot breathe on their own. While this procedure can be lifesaving, it also increases the risk of developing pneumonia. In the study, the researchers stressed a conversation between a physician and the family of a patient with meningitis who was afraid of dying in a nursing home. The doctor expressed concern that using intubation would cause pneumonia and keep the patient from fulfilling her wish of living out the rest of her life at home.

The researchers observed this cognitive reframing with another emotion: hope.

“A terminally ill patient may have hope for a cure. A provider may say, ‘Yes, you should have hope, but you should have hope for comfort and relief,'” Thomas says.

Reference: Futurity (Feb. 21, 2022) “Communication is Key to Guide Patients to Best End-Of-Life Plan”