2014_03_25_ICS_One of the most difficult conversations in palliative care is addressing end-of-life decisions

"One of the most difficult issues in palliative care is dealing with end-of-life decisions." So said at the University of Navarra Carole Robinson, associate professor at the University of British Columbia (Canada). The expert was one of the speakers at the course 'Discovering the potential of the research qualitative in palliative care', organized by the ATLANTES program program of Institute for Culture and Society (ICS).

Professor Robinson explained that she has done research on how to have these subject conversations with patients "in an environment where they feel supported, can express themselves and talk to the family about their wishes, and where their hope is not damaged." These programs of study have helped her to understand "that the essential thing is to know how they understand their disease."

The specialist pointed out that in her long experience with advanced lung cancer patients, she has observed through qualitative methods of research that although they understand that treatment can simply slow down the symptoms, they continue to yearn for a cure.

"I have learned that if we know how they conceive of their illness, their experiences with death, and their values and beliefs about what makes life worth living, then the professional can help talk about situations where they cannot express themselves verbally and that other people will have to do it for them. At that point they see the difficulty of the status and then they open up to dialogue about end-of-life decisions," she stressed.

The hypothetical question

He calls this procedure "the hypothetical question," a method by which the palliative care professional can steer the conversation toward end-of-life choices without the patient having to leave his or her comfort zone. "To pose it," he added, "it is important that he be informed about unanticipated situations in which he may not be able to make his opinion known, such as during heart failure or intubation.

In that sense, he revealed that "the same people who hoped to recover chose not to be resuscitated in the event that their heart stopped beating or they could not breathe, although their hope remained intact".

From agreement with this, he noted that "families can be prepared to make the most opportune decisions and help people to express their wishes without damaging the relationship with the patient and without destroying their hopes".