Integrated Palliative Care of Respiratory Disease by Stephen J. Bourke & Tim Peel

Author:Stephen J. Bourke & Tim Peel
Language: eng
Format: epub
ISBN: 9783030189440
Publisher: Springer International Publishing

Doctors’ Views

When doctors make decisions on the appropriateness of withholding treatment they are influenced by what they believe to be fairly objective assessments of the patient’s global quality of life, physical comfort, mobility and mood [21]. Critically however, the doctor’s estimate tends to be worse than patient’s own estimate of his/her quality of life.

Perhaps doctors are influenced by how they imagine they would view things if suddenly confronted by the predicament the patient finds himself/herself in. However well intentioned, this seems to be wrong. Trying to second-guess a patient’s wishes makes little sense. It is no substitute for open communication. We also need to remain acutely aware of how much we influence the decisions of our patients. We must strive to be as balanced as possible.

When doctors and patient do open up the communication channels it is often the doctor who learns more. Natural assumptions about what the patient may think or be concerned about are often wrong. It may well be that mortality per se is not the issue. A common overriding fear is of dying of breathlessness or “suffocation”. Once the concern is understood some relevant reassurance can often be offered. Perhaps the best way forward is to establish a rapport between physician and patient that allows open regular discussion of the individual patient’s hopes and expectations as well as fears in relation to symptom control and evolving end-of-life care. This would form the basis of an effective integrated palliative care approach focusing on quality of life at all stages. For many this broader approach may be more appropriate and more productive than focusing primarily on death [22].

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