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End-of-Life Care: Tips for Resolving Conflicts

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Three guidelines to effectively discuss end-of-life care

Many patients and their loved ones find it difficult to discuss end-of-life care with physicians. The conversation can become even more difficult if patients or their families disagree with a healthcare provider’s recommendations. However, early, clear communication between patients and their care teams, choosing objective surrogates to represent patients, and involving third parties such as ethics committees can help avoid or resolve conflicts, according to Mayo Clinic experts Christopher Burkle, MD, JD, and Jeffre Benson, MD.

“Health care professionals in the United States have struggled with the importance of maintaining patient autonomy while attempting to practice under the guidance of treatments based on beneficial care,” Burkle, the study’s lead author, says in the November issue of Mayo Clinic Proceedings.

Burkle and Benson offer the following 3 guidelines to effectively discuss end-of-life care:

·      Clear communication: The best way to avoid disagreement regarding whether medical care should continue is through early and clear communication between healthcare providers and patients (or their surrogates). According to recent studies, more than 95% of such disputes are resolved through mediated meetings involving physicians and patients/surrogates.

·      Choose objective surrogates if patients cannot represent themselves: The surrogate’s role is to represent the desires of the patient while concealing his or her own judgment. However, it is important to understand that medical surrogates struggle to find balance between their wishes for the patient and the patient’s own wishes. Studies have found that many surrogates fail to accurately predict a patient’s treatment wishes and are more likely to show bias by overestimating the patient’s desire for continued treatment during disputes.

·      Involve third parties when necessary: A third party becomes necessary when healthcare providers and patients (or their advocates) cannot agree on end-of-life care. Beginning in 1992, the Joint Commission required hospitals to establish procedures for considering ethical issues. The most common response to this requirement is hospital-based ethics committees.

“End-of-life care will continue to be an ongoing discussion within the medical community; however, it is important that medical care providers and patients/medical surrogates continue to dialogue,” Burkle says.

Source: Mayo Clinic.