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QJM 2007 100(12):791-797; doi:10.1093/qjmed/hcm114
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A communication model for encouraging optimal care at the end of life for hospitalized patients

S. Workman

From the Division of General Internal Medicine, Dalhousie University, Halifax Nova Scotia, Canada

Address correspondence to Assistant Professor Stephen Workman, Room 437 Bethune Building, QEII HSC, Halifax Nova Scotia, B3H 2Y9, Canada. email: sworkman{at}dal.ca


  Abstract

Multiple studies have demonstrated that treatment at or near the end of life is rarely optimal. Unwanted death-prolonging treatments are frequently provided and open communication about death and dying is often lacking. Early effective communication about goals, prognosis and options would improve patient care at or near the end of life by enhancing choice and facilitating palliative care. A five-step sequential approach to communicating with patients at risk of dying in hospital about treatment goals and outcomes (and/or their family members) is presented. The five steps are founded upon the recognition that trials of life-sustaining treatments are also, by definition, trials of palliative care. A narrative review of currently available qualitative and quantitative research is used to support the recommendations.


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