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The best way to convey the worst. Steve Philpot highlights flaws in our approach to discussions surrounding terminal illness and palliative care.
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Craig’s storyTALKING AT THE DEATH
We didn’t realise he was dying
Didn’t know when he was going to die
Didn’t feel certain that death was approaching
Assumed he already knew
Had the conversation but he didn’t remember
Didn’t have time to have the conversation
Didn’t feel we had the skills to have the conversation
Thought he might prefer not to know
Didn’t want to take away his hope
WHY DIDN’T WE SAY ANYTHING?
We didn’t realise he was dying
Didn’t know when he was going to die
Didn’t feel certain that death was approaching
Assumed he already knew
Had the conversation but he didn’t remember
Didn’t have time to have the conversation
Didn’t feel we had the skills to have the conversation
Thought he might prefer not to know
Didn’t want to take away his hope
WHY DIDN’T WE SAY ANYTHING?
We didn’t realise he was dying
Didn’t know when he was going to die
Didn’t feel certain that death was approaching
Assumed he already knew
Had the conversation but he didn’t remember
Didn’t have time to have the conversation
Didn’t feel we had the skills to have the conversation
Thought he might prefer not to know
Didn’t want to take away his hope
WHY DIDN’T WE SAY ANYTHING?
We didn’t realise he was dying
Didn’t know when he was going to die
Didn’t feel certain that death was approaching
Assumed he already knew
Had the conversation but he didn’t remember
Didn’t have time to have the conversation
Didn’t feel we had the skills to have the conversation
Thought he might prefer not to know
Didn’t want to take away his hope
WHY DIDN’T WE SAY ANYTHING?
We didn’t realise he was dying
Didn’t know when he was going to die
Didn’t feel certain that death was approaching
Assumed he already knew
Had the conversation but he didn’t remember
Didn’t have time to have the conversation
Didn’t feel we had the skills to have the conversation
Thought he might prefer not to know
Didn’t want to take away his hope
WHY DIDN’T WE SAY ANYTHING?
Feedback to parent units
Plan at ICU/ED discharge
Role of MET service training
Drive culture change in hospital
Drive culture change outside hospital
WHAT CAN WE DO IN CRIT CARE?
Patients should and want to know if they are dying
We can discuss dying in the face of uncertainty and without extinguishing hope
Much more effective outside of the critical care arena
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