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Evolving the conversation with your patients from “I’m sorry you are going to die” to “Let me help you experience a good and peaceful death”. This video will demonstrate how to clearly communicate the nine evidence-based elements to a good and peaceful death and how to structure that conversation with your patient. What you will learn from this module: No matter what someone’s eventual cause of death will be, including our own, people will benefit from learning the 9 elements and how to achieve them. The timing of when to have such a discussion with a patient with advanced cancer very much influences her willingness to listen to her oncology specialist/provider of care, and be ready to embark on fulfilling these 9 elements. There is benefit in being able to tell a patient that you, her doctor, has already completed these 9 elements for yourself, demonstrating that they are appropriate for everyone, no matter their current health status. By doing so, it doesn’t cause the patient to feel that they have to complete it because they are dying. Patients all have different personal psychosocial experiences over their lifetime and these experiences and relationship with family and others influences how they approach each of these elements and complete them. Fulfilling these 9 elements cannot be achieved in a few days. This is why it is important to have this discussion in advance of a patient literally approaching end of life. Patients may need as much as 2 months to complete all of these elements, each one taking a different length of time. Helping patients learn about the 9 elements and making it an assignment for them to complete is a way to give patients something they can control during a time that they feel they cannot control anything. Some answers to these 9 elements will be surprising to you, and will provide you greater insight into your patients’ psychosocial history and current needs. You as the patient’s provider of care should launch the discussion about the 9 elements however there is no expectation that you need to help the patient literally think about each one with you and provide the answers. It is also okay to delegate someone like a nurse navigator, psyche nurse from your oncology team, social worker, or therapist to review in detail with the patient each element. Each element carries its own weight in the eyes of the patient. Some elements may be considered by her to be the most important ones to her where another patient identifies totally different ones that she sees as major. Making sure however that legal and financial affairs are in order is critical for everyone, including ourselves, and should be prioritized as such.

Educating your advanced cancer patients about the value and importance of not postponing joy. There is a tendency to avoid discussing the future, too far in advance, with your patients with advanced disease. The sooner we bring up the topic of not postponing joy, the better however. Patients may even say that they are planning on a family vacation to Disney World in 2 years. Your thoughts immediately go to estimating when she will be likely too ill to go but may not be verbalizing this to her. You don’t want to take away hope and burst that bubble. It however isn’t fair to the patient to be assuming that no response from you regarding such an announcement, or worse, saying that this sounds great, is doing her an injustice. Additionally, though she may still be living in two years and technically able to go to Disney World, she may very well be spending her time in the hotel room and not enjoying herself and her children/grandchildren doing park activities. Her goal wasn’t to be in a bed too weak to partake of this important family adventure. This is why a discussion about “Don’t Postpone Joy” is so important. It fits for many clinical settings too.

Of everything we do for our patients, the most important thing we can give them is honesty. What you will learn from this module: Learn that being honest with patients about their disease and its prognosis is very important for patients to know so they can plan out the remainder of their lives. Honesty doesn’t take away hope; it helps the patient move through phases of hope. 50% of the time, doctors do not disclose the patients’ actual prognosis. Patients do not understand or know the difference between palliative chemotherapy and active chemotherapy treatments, unless they are told.  Teaching patients to be optimistic for as long as it is realistic, while having an end of life plan in place should be our mantra. Avoidance of honesty may be linked to an oncologist’s feelings of believing they have failed the patient by not being able to save or sustain their life.

It is a process that fosters shared decision making that includes exploring and comparing the benefits, harms, and risks of each health care option through meaningful dialogue about what matters most to the patient. The doctor and patient need to use evidence-based information while working together to make the best possible treatment decisions.