Discussing palliative care with patients

Palliative care focuses on relief of suffering, psychosocial support, and closure near the end of life. Even experienced physicians often struggle when initiating complex, emotionally laden discussions about palliative care with seriously ill patients and their families. We use two hypothetical case scenarios to illustrate how physicians can initiate these discussions and to emphasize and illustrate several communication techniques. Physicians can elicit a patient's concerns, goals, and values by using open-ended questions and following up on the patient's response before discussing specific clinical decisions. Physicians can acknowledge patients' emotions, explore the meaning of these emotions, and encourage patients to say more about difficult topics. Physicians should also screen for unaddressed spiritual and existential concerns. Some patients may make statements or ask questions that are difficult for physicians to respond to. We provide examples of responses that align the physician with patients' wishes without reinforcing unrealistic plans. Exploring such difficult issues may lessen feelings of aloneness even when the physician cannot "fix" the problem, and it raises new opportunities for patients to find comfort. In addition to addressing physical suffering, physicians can extend their caring by acknowledging and exploring psychosocial, existential, or spiritual suffering. As patients struggle to find closure in their lives, active listening and empathy have therapeutic value in and of themselves.