Intended for healthcare professionals

Rapid response to:

Practice What Your Patient is Thinking

Finding hope in dying

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l2416 (Published 17 July 2019) Cite this as: BMJ 2019;366:l2416

Rapid Response:

Re: Finding hope in dying

Failure to establish reasonable limits and failure to establish preferences for palliative care results in many patients dying a poor death in an unwanted manner. This is especially true for patients admitted to hospital where tests and treatments are readily available and there is a strong bias towards intervention.

Algorithmic solution:

Know your patient, establish/explore the impact of their illness on them and their family.

Ask lots of questions/FIFE--Feelings Ideas Function Expectations

Give / establish context / prognosis if clinically indicated at that time.

When appropriate* give bad news about CPR and ICU as non effective option

(Do not tailor opinion about options based upon preferences or unrealistic expectations or goals. Death remains an unavoidable outcome irrespective of treatment in many circumstances.)

*(If terminal illness present, terminal trajectory present, and you believe that no reasonable physician would RECOMMEND CPR or admission to an ICU.)

Offer palliative care as an option.

Compassionately negotiate demands for treatment should they arise.

Competing interests: No competing interests

19 July 2019
Stephen R Workman
MD
Dalhousie University
QEII HSC Halifax NS Canada