End of life is a 'feeling world'
For physicians to explain to patients that there are alternatives at the end of life that can be more valuable than chemotherapy, they first must believe it themselves, says Larry Cripe, MD, an oncologist who teaches hematology/oncology at Indiana University School of Medicine in Indianapolis. Then, they have to develop the communication skills to get that message across, he says.
"It's not about understanding a quantitative prognosis; it's about feeling and believing that end-of-life care is the better way of taking care of that patient," he says. "[We need] to get around the thinking that if someone dies, it's a failure. Once we figure out how we do this, and get around the emotional and spiritual distress, that's what we need to teach our patients."
Cripe says in framing hopeful discussions about death, he relies on a quote from the book Young Men in a Fire by Norman Maclean: "In a journey of compassion, what we have ultimately as our guide is whatever understanding we may have gained along the way of ourselves and others, chiefly those close to us, so close to us that we have lived daily in their sufferings. From here on, then, in the blinding smoke it is no longer a 'seeing world' but a 'feeling world' the pain of others and our compassion for them."
Evidence of the need for such communication skills, Cripe says, is the breakdown of people he sees dying of cancer. You can divide them into three buckets, he says. Relatively few people end up in the "chemo-to-the-very-last-minute" bucket, he says. "They're a hard nut to crack, because they want to pursue it to the very end," Cripe says. A few more end up in the "life-ending naturally" bucket, who die in hospice or at home, taking advantage of end-of-life options.
However, a lot of people end up in what Cripe calls the "indeterminate" bucket. These people are in the hospital and might not even aware they're dying, he says. "These are the people I worry about. Nobody has ever sat down and told them, 'You're in the phase of your disease where we should talk about taking care of you as you die,'" he says. "And we can't teach this to our patients until those of us who value this behavior understand how we value this behavior."
For physicians to explain to patients that there are alternatives at the end of life that can be more valuable than chemotherapy, they first must believe it themselves, says Larry Cripe, MD, an oncologist who teaches hematology/oncology at Indiana University School of Medicine in Indianapolis. Then, they have to develop the communication skills to get that message across, he says.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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