An excellent New Yorker expository piece entitled:
Dying words .
In summary, in telling a person they are about to die there are general considerations:
1) There is no right way
2) There are many wrong ways
3) Find a quiet, comfortable, private place where the patient, family and doctor can sit quietly without interruptions.
4) Try to have an idealised script to deliver news so that nothing is forgotten.
5) Avoid bluntly delivering information and just leaving the patient.
6) Involve the patient in the process, to a level they are comfortable with.
7) Explain the details of the disease at an appropriate level.
6) Explain your terminology esp. palliative vs curative, remission.
8) Put prognosis (the course of the disease), into context. Bare statistics do not tell the full story and do not say much about the particular patient.
9) Explain the objectives of palliative treatment
10) In discussing treatment options, always remember to inform the patient of side-effects, and especially side-effects that may be specifically relevant to the patient.
11) Management involves physical AND emotional issues amongst others. Refer to the concept: ars moriendi - the art of dying.
12) Consider advanced or end of life directives to cater for situations where the patient is not competent to consent i.e. ask the patient what they'd like to do in certain eventualities such as the worst-case scenario.
13) Ask the patient what their expectations are. A patient and their family's expectations of death may differ considerably to the actual event. They may need to be prepared.
14) Try to answer patient's questions in as straightforward a manner as posible, avoiding jargon. Try to avoid skirting the truth.
15) Don't discuss the patient with other family or friends without the patient's involvement or consent.
Conclusion: Palliative care operates on many levels alleviating some of the suffering, maximising quality of life and the economic costs associated with terminal illness ( Generally, greater proportion of health care costs are consumed in the last few weeks of life than for any other period). It is worth the investment..
In addition, some other stuff of note:
1) No matter how carefully you discuss the situation with the patient, they will only retain a minority of it, so write the salient points down, or record them on tape.
2) Sometimes the doctor also does not want to let go of the patient and may view death as a failure on their own part.
Seminal works:
On Death and Dying, Elisabeth Kübler-Ross
How We Die, Sherwin Nuland
The Journal of Clinical Oncology, March 2002.
Organisations:
Open Society Institute - Project on death in America
Robert Wood Johnson Foundation - Palliative care centre
Significant people in the field:
Diane Meier
Kathleen Foley
It's odd, Jerome Groopman, who wrote the article has a considerable media presence which lead me to an automatic distrust probably because of the quick fix tv gods such as Dr Phil. from Oprah. Note to self: " I must not make assumptions". Two of his books were the premise for the series Gideon's Crossing, he regularly writes for the New Yorker and holds esteemed positions within the medical community.