Communication is the first objective, and should start with the doctors. In his role as doctors are often the object of improving the gap between life-saving and quality of life to the bridge maintenance, so they often struggle to balance hope with sincerity. Determination "amount of information", "in which space of time" and "at what level of immediacy in these patients" requires a commitment that skillful mature with age and experience.
Leadership of a physician should be highly personalized and must include the risks and benefits of different interventions the patient symptom burden, the time line before taking into account the age and stage of life of the patient, and the patient's quality system support.
At the same time, it is common for the patient and his family too close to concentrate in life, especially when a diagnosis made for the first time. You need to do with shock, which can then give rise to a complex analysis, which intersects often with a sense of guilt, remorse and anger. Fear must be managed and channeled. This confusion may take some time, but a sharp decline, the results of the diagnostic test or an awareness inside it usually signals a transition and leads patients and, finally, recognize and understand that death is approaching.
Once the acceptance arrives, the end-of-life decision naturally follows. Ongoing denial that death is approaching only the compressed timeline for these decisions, adds anxiety, and undermines the sense of control over their own destiny.
With the assumption, the underlying goals of the quality of life and comfort for the rest of the days, weeks, or months. Doctors, hospice, family and other health care professionals to focus on the evaluation of the patient's physical symptoms, psychological and spiritual needs and define end-of-life goals. How important it would be for a patient, the wedding of a niece or see one last Christmas, and these are realistic goals to be pursued?
To schedule a death with dignity, we need to take death as part of life, an experience embraces be ignored when it comes time to recognize. Are you ready?
Mike Magee, MD, is a Senior Fellow in the Humanities of the World Medical Association, Director of Pfizer Medical Humanities Initiative and host of the weekly web cast "Health Politics with Dr. Mike Magee."
