Perspectives on Care at the Close of Life Section
Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Author Affiliation: Palliative Care Center,
Division of Neoplastic Disease and Related Disorders, Medical College of Wisconsin,
As patients approach the end of life, their disease process may create
an immediate life-threatening emergency, yet invasive interventions may be
less likely to provide benefit while carrying the same or greater risks. Knowing
when it is time to shift from life-prolonging to more palliative approaches,
focused on quality of life and comfort, is emotionally and clinically challenging
for patients, families, and physicians. Key factors in the decision process
include prognosis, risk-benefit analysis of the proposed intervention, current
symptom burden, temporal pattern of the illness, patient’s age and life
stage, and the patient’s goals of care. A structured approach to decision
making includes assessing the patient’s physical, psychological, and
spiritual needs; assessing the patient’s support system; discussing
prognosis; and assessing patient-specific goals. Physicians can best help
patients decide which treatments are appropriate by taking the necessary time
to explore all curative and palliative care options, providing honest and
timely prognostic information, making clear recommendations, facilitating
patient-family discussions, and affirming patient choices.
Weissman DE. Decision Making at a Time of Crisis Near the End of Life. JAMA. 2004;292(14):1738–1743. doi:10.1001/jama.292.14.1738
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