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Perspectives on Care at the Close of Life
Clinician's Corner
July 20, 2005

Beyond Advance DirectivesImportance of Communication Skills at the End of Life

Author Affiliations
 

Perspectives on Care at the Close of Life Section Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

 

Author Affiliations: The Center for Palliative Care and the Department of Medicine, Veterans Affairs Medical Center and Duke University, Durham, NC.

JAMA. 2005;294(3):359-365. doi:10.1001/jama.294.3.359
Abstract

Patients and their families struggle with myriad choices concerning medical treatments that frequently precede death. Advance directives have been proposed as a tool to facilitate end-of-life decision making, yet frequently fail to achieve this goal. In the context of the case of a man with metastatic cancer for whom an advance directive was unable to prevent a traumatic death, I review the challenges in creating and implementing advance directives, discuss factors that can affect clear decision making; including trust, uncertainty, emotion, hope, and the presence of multiple medical providers; and offer practical suggestions for physicians. Advance care planning remains a useful tool for approaching conversations with patients about the end of life. However, such planning should occur within a framework that emphasizes responding to patient and family emotions and focuses more on goals for care and less on specific treatments.

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