Recently, reading an article in Journal of the American Medical Association and also a Boston Children’s Hospital blog made me think about the conversations we are not having.
Amy Sanderson, MD, an intension at the Boston children’s hospital, has survey with doctors and nurses working in oncology, intensive care and heart care. Two -thirds of those questioned agreed that not resuscitation (DNR) should guide the decisions made during the cardiopulmonary arrest. However, 69% said that after writing an MRN prescription, care changes.
What changes?
Dr Sanderson’s survey clinicians believed that the emphasis is more focused on comfort care, but that there may also be limits set for or withdrawing other interventions. Confusion develops when the objectives are deducted from an MRN order and preferences are not included. Obviously, what is often lacking is a discussion on the objectives of end -of -life care or decisions.
What is embarrassing?
88% of the clinicians of this survey said they had little or no training during medical schools or nurses who would prepare them for end -of -life discussions.
Parents of pediatric patients also have obstacles in the form of unrealistic expectations, a limited understanding of the prognosis and a lack of preparation for a discussion.
Although it is true that parents are not ready, is it not possible that they are waiting for their health care providers to open the door to the conversation?
Overview
Although this survey focuses on pediatric patients and their families, I wonder if we can extrapolate an application from all patients and their families.
How often is an end-of-life discussion avoided? How often is confusion on care objectives? Do families in general have unrealistic expectations for their loved ones or a limited understanding of the prognosis?
More importantly, if there is a lack of education on end-of-life discussion techniques for pediatric clinicians, why would it be assumed that there was an education for the adult clinician?
Are there any answers?
It is essential to determine the overall care objectives for our patients at any age during the recommendation or response to a resuscitation order. Each member of the health care team needs to know what care for the care and / or his family want to support these decisions with appropriate interventions or therapies.
Until the education of clinicians includes adequate instructions concerning the end -of -life discussions of patients and the family, it becomes incumbent on each establishment or health system to provide this education as part of their orientation and their training.
We have to do better
To quote Dr. Sanderson, “although there has been progress in training in palliative care and communication, we can do better. We must do better for our most vulnerable patients and their families. ”
Last update: February 11, 2022
