For Clinicians

People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come — and escape a warehoused oblivion that few really want.
—Dr. Atul Gawande
Healing is the central goal of life. I’m not speaking of physical healing; a person can die healed. What I mean by healing is a shift in our quality of life away from anguish and suffering toward an experience of integrity, wholeness and inner peace.
—Dr. Balfour Mount

To those of you involved in healthcare, particularly in end-of-life care, thank you for taking the time to visit this site. I imagine that much of it is familiar to you. I’ve added this section because chaplains sometimes get an earful from patients about their doctors, nurses, and clinicians. Most of it is very positive, but I’ve been asked to pass along a few requests.

Patients and family members are asking for clearer communication from their clinicians. I know this requires an investment of time, which is already in short supply. I believe the call is for better quality communication rather than for quantity. Please remember that our patients are often overwhelmed, perhaps numb, and therefore have a limited attention span. A powerful invitation: “Please let me know what you want so that I can help you.”

People have goals and priorities besides living longer. Asking and learning about these priorities empowers us to provide better care, no matter our specialty. Patients also want the truth about prognosis, though the tone and timing of its delivery is important. Please trust that you will not harm your patient by talking about end-of-life issues. In fact, most patients will be relieved you brought it up. Anxiety is normal for both patient and clinician during these discussions. Please don’t let this anxiety keep you from the Conversation. To repeat the North Star questions: “What’s most important to you right now?” and “How can I help?”

Consider taking advantage of excellent communication resources for clinicians, especially when it comes to the art of sharing a prognosis. In case you’re not familiar with it, Ariadne Lab’s Serious Illness Conversation Guide is a gold standard resource. In addition, the doctors who founded Vital Talk have created important teaching tools to help clinicians be more aware of and address their patient’s emotional well-being. Clear communication and collaborative decision-making can make a measurable difference as patients move through the care continuum. For doctors who recognize this need but “don’t have enough time,” please consider asking a trusted colleague to follow up in your place. 

Basic Principles for Clinicians to
Improve End-of-Life Communication

  • With essential information, consider writing it down for the patient and family.
  • Provide prognostic information as a range; acknowledge uncertainty, e.g., “We think you have weeks to a few months, but it could be shorter or longer.”
  • Allow for pauses and silence.
  • Listen at least half the time.
  • Acknowledge and explore patients’ strong emotions.
  • Be careful to limit information in response to patients’ emotions.
  • Avoid focusing solely on medical procedures and overusing medical terminology.
  • Focus instead on the patient’s quality of life, goals, fears, and concerns.
  • Use plain English, and an interpreter, if need be, speaking clearly and slowly, ideally from a seated position.
  • Strive to document and exchange information about patients’ values and goals while charting and reporting to your team. By understanding and embracing the general ethos of palliative care, every clinician can choose to provide meaningful, patient-led care. Thank you.