Discussing Future Course of Action

As a doctor, it is important to communicate a bad prognosis accurately without giving false hope or any ambiguous or mixed messages about the prognosis.

Discussing Prognosis with the Patient

    Understanding the patient’s emotional state and readiness to discuss future course of action can help you manage the therapy in a     better manner. Some useful questions and one-liners that can help you have a fruitful discussion with the patient are:

  • ‘Tell me what you know about this disease?’
  • ‘Is this a lot to take? Do you want me to discuss this sometime later?’
  • ‘Let me know when you are ready to continue.’
  • ‘How are you and your family coping with this news?’
  • ‘Is anything interfering with your everyday quality of life?’

Handling Difficult Questions

When the patient and his/her family have accepted the diagnosis or a bad prognosis, the next hurdle the doctor often faces are the difficult questions like:

  • How long have I got?
  • Is there a cure?
  • Why me?
  • What happens after this? (end of life)
  • Would alternative therapies help?

Many of these questions are rhetorical and may have no clear answers.

Pointers that could help you deal with such difficult questions:

  • Check reason for questions—for example, “Why do you ask that now?”
  • Show interest in patient's ideas—for example, “I wonder how it looks to you?”
  • Confirm or elaborate—for example, “You are probably right,” or
  • “You are right in thinking that these complementary therapies don't cure, but they seem to improve some patients' quality of life”
  • Be prepared to admit that you don't know—for example, “The uncertainty must be hard to take, but I'm afraid we just don't know at this moment”
  • Empathize —for example, “Yes, it must seem unfair”

Discussing Future Course of Action with the Caregiver

It is necessary for you to understand how well the caregiver and the patient’s family is aware of the situation and prepared for the future course of action.

  • Listen to the caregiver’s fears and concerns with empathy.
  • Educate the caregiver regarding treatment options and what role he/she may have to play in future decision making for the patient.
  • Tackle their spiritual or religious queries with patience and understanding.
  • Help them prepare themselves for taking care of their loved one

Handling Emotional Reactions

When caregivers and family members accept that someone they love will die in the near future, there are often strong emotional reactions which need to be expressed and diffused.

  • Anger: Anger is commonly expressed by the caregivers or even the patient. Try to establish the cause of anger, rather than allowing caregivers to displace feelings onto professionals.
  • Guilt and Blame: Some patients may feel that the illness is their fault or the fault of someone else. You may not be able to take away such guilt or comment when blame is being given, but, exploring that particular aspect with the caregiver or family, may help to put things in a more realistic perspective.

Download Patient Information Kit

References:

  • Ngo-Metzger Q, August KJ, Srinivasan M, Liao S, Meyskens Jr FL. End-of-Life care: guidelines for patient-centered communication. American family physician. 2008 Jan 15; 77(2).
  • Faulkner A. ABC of palliative care. Communication with patients, families, and other professionals. BMJ: British Medical Journal. 1998 Jan 10; 316(7125):130.
  • Clayton JM, Hancock KM, Butow PN, Tattersall MH, Currow DC, Adler J. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Medical Journal of Australia. 2007 Jun 18; 187(8):478.