Discussing palliative care with patients

Palliative care focuses on relief of suffering, psychosocial support, and c losure near the end of life. Even experienced physicians often struggle whe n initiating complex, emotionally laden discussions about palliative care w ith seriously ill patients and their families. We use two hypothetical case scenarios to illustrate how physicians can initiate these discussions and to emphasize and illustrate several communication techniques. Physicians ca n elicit a patient's concerns, goals, and values by using open-ended questi ons and following up on the patient's response before discussing specific c linical decisions. Physicians can acknowledge patients' emotions, explore the meaning of these emotions, and encourage patients to say more about difficult topics. Physi cians should also screen for unaddressed spiritual and existential concerns . Some patients may make statements or ask questions that are difficult for physicians to respond to. We provide examples of responses that align the physician with patients' wishes without reinforcing unrealistic plans. Expl oring such difficult issues may lessen feelings of aloneness even when the physician cannot "fix" the problem, and it raises new opportunities for pat ients to find comfort. In addition to addressing physical suffering, physicians can extend their c aring by acknowledging and exploring psychosocial, existential, or spiritua l suffering. As patients struggle to find closure in their lives, active li stening and empathy have therapeutic value in and of themselves.