For Stuart Goldberg, MD, an oncologist at Edison, N.J-based Hackensack Meridian Health John Theurer Cancer Center, physicians must learn how to have honest, constructive conversations about palliative care with patients.
Dr. Goldberg — who also serves as chief scientific officer at Cota, a cloud-based data and analytics platform — spoke to Becker's Hospital Review about how end of life conversations are often delayed past the point of usefulness. Dr. Goldberg and his team of researchers developed a seven-item instrument, which they administered to patients to identify their distress level on a likert scale. His research, published in the May 2016 issue of the Journal of Palliative Medicine, found the use of such an instrument improved physicians' ability to determine the best possible care for patients.
"Doctors don't like to talk about end of life care. Telling a patient their end of life treatment isn't working isn't a great conversation. Patients, too, don't want to tell doctors they've given up. Even if they're doing poorly, they don't express it to their doctors. … So both sides are looking at each other, and neither party wants to engage in that last round of chemotherapy, that last round of an unwanted, expensive treatment. … [Physicians] can't predict when a patient will die. … We need to flip the paradigm. [We need] to start asking the patient 'How are you doing? Are you distressed?' … We need to listen to the patient and have them tell [their physicians] when they're distressed so that doctors can determine the best course of action to help the patient, whether that means continuing treatment or transitioning to palliative care."
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