Truth, gently told, need not end hope
Patient care providers should take care to let patients express what their hopes are and to reframe those hopes, gently, with truth, says Vincent Guss Jr., MDiv, chaplain at Falcons Landing Air Force Retired Officers Community in Potomac Falls, VA.
Hope that is "reframed" can be transformed from "hope for a cure" to hope for dignity, elimination of suffering, and greater wholeness.
"Certainly, a patient can hope to get better, hope to be cured, and you should encourage the patient to express those feelings," he says. "You can acknowledge those hopes and feelings, not put them down, but you don't have to feed into it either."
In his role as a clinical chaplain, Guss says he often works to help patients hear and understand what their physicians are saying and with physicians on how best to deliver that information. "St. Paul says [in the book of Ephesians], 'Speak the truth, speak it with love and gentleness,' and I think that's how it needs to be done by physicians," Guss says.
It can be difficult for anyone involved physician, patient, or family to broach the subject of ending treatment and focusing on end-of-life care, but Guss says to do so is not only courageous, but compassionate. "It takes an act of courage to break the conspiracy of silence," he says.
Whether a patient doesn't want to let his family down by bringing up end-of-life care and relinquishing chemotherapy, for example, or the family members avoid talking about death so as not to discourage the patient, Guss says, "Most people are well intentioned, but sometimes those good intentions to be positive are creating negativity because everyone is not dealing with their inner feelings, and too often, those words of blessing and goodbye don't get spoken."
Larry Cripe, MD, an oncologist who teaches hematology/oncology at Indiana University School of Medicine in Indianapolis, would like to see the definition of "prognosis" expanded. "Yes, prognosis is the quantitative evaluation of survival, but the expanded definition is to describe the possibilities that remain, working through the implications of the possibilities and impossibilities of that patient's prognosis," he says.
Presenting a description of what the patient likely will experience, rather than emphasizing solely a measurable outcome, invites dialogue about the possibilities, Cripe suggests. "It's more about articulating a process than articulating goals," he says.
The physician's own feelings about death have an impact on what he or she conveys to the patient, Guss says. "He or she can impart a fear of death based on [his or her] own discomfort, or see it as an opportunity to explore the awe of living, of which dying is part," he says. Drawing on family and other members of the care team at such times can be useful, he adds.
"The utmost gentleness, sensitivity, and respect for one's culture and dignity must be exercised through active, interactive listening and intentional presence," he explains. "Clinically trained chaplains and clergy can be a great asset to the health care team at such a time, whether or not the dying person or his family has a religious orientation or background."
Patient care providers should take care to let patients express what their hopes are and to reframe those hopes, gently, with truth, says Vincent Guss Jr., MDiv, chaplain at Falcons Landing Air Force Retired Officers Community in Potomac Falls, VA.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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