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I stood next to the bed of my dying patient, knowing that I couldn’t say what she needed to hear…She asked if she should call her family, talk to a chaplain, arrange for hospice. I wanted to say “yes.” Instead, I said what I was supposed to say, “I don’t know. Let’s ask your oncologist in the morning.” I left her room, hoping that death wouldn’t reach her before her longtime oncologist could explain that there would be no more treatment.
She died the next morning, before she could have that conversation.
This example, described in the article “Should medical residents be trusted with end-of-life conversations?” by Ravi Parikh for Stat News is a common one that many residents face. Residents are often thrust into difficult situations where end-of-life care or goal-of-care discussions are inevitable. However, training for conducting these discussions is not uniform, and some attendings prefer that residents not lead these discussions, as they may not know the patient as well.
How do we work within this construct to improve end-of-life or goals-of-care discussion for all involved (patient, resident, attending)? This discussion will highlight some of the many issues and barriers facing residents in this area. Questions to be addressed include:
Is it appropriate for residents to have end-of-life discussions with patients?
Should there be required training for residents before they can be allowed to have end-of-life discussions with patients?
How can we train residents to improve their communication skills with regards to end-of-life discussions?