How to lead difficult conversations with families

 In Clinical Care

The COVID-19 pandemic has catapulted serious illness and mortality to the forefront of America’s consciousness. People are hungry for facts and honesty instead of rumors, half-truths and paranoia.

Situations like these underscore how unprepared many physicians and other clinicians are to have difficult discussions with patients and families – especially end-of-life conversations.

In fact, only 17% of Medicare patients surveyed in a Kaiser Family Foundation study said their doctor had discussed end-of-life care with them. By sharp contrast, 90% said doctors should discuss end-of-life issues with their patients.

A study in 2016 revealed that 88% of physician residents said they received little to no training in end-of-life care during their residencies. So it’s no wonder that many doctors feel ill prepared and often avoid difficult discussions about grim prognoses. And when they do lead such conversations, they may not be handling them in the best way for patients and their families.

In sharp contrast, Tim Short, MD, has made it part of his personal mission to enter these challenging conversations with empathy, compassion and a commitment to putting the patient and family first. Dr. Short is Associate Professor of Palliative Care at University of Virginia Medical Center. He has been honing his approach to end-of-life discussions for decades, turning difficult conversations into productive, personalized goals-of-care meetings with families.

During a recent interview, Dr. Short shared these observations: “The most common model of family meetings that I see looks like this – the team walks in with a trail of long coats to short coats, an array of the healthcare professionals surround the patient and family in the room, and then they start to talk, and they explain an update on the patient’s condition. Sometimes they do a good job of speaking in an understandable language that the patient and family can relate to. Sometimes they just go into medical jargon and speak over their heads, and at the end of their update, they step back, fold their arms, and say, ‘What do you want to do?’ So there’s this information dump, and then a question and a complete shift of burden for the decision to the patient and family. And more often than not, you’re looking at a deer in the headlights.”

Instead, Dr. Short has learned to lead with a focus on the patient as a person, not a medical condition. “When I come in to meet a family,” he explained, “I might say something like, ‘I’ve been looking at your mother’s chart for the last 30 minutes. I’ve talked to all her consultants. I’ve reviewed all her scans and all her labs. I know a lot about your mom’s medical condition, but I don’t know who she is and what’s important to her. Do you think we could start on that note?’”

In our podcast episode with Dr. Short, he shares a lot more wisdom on effective approaches to leading difficult conversations with patients and their families. Please listen when you have time. We all can learn a lot from Dr. Short’s experience and advice.

 

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