Beyond advance directives: importance of communication skills at the end of life. Export

@article{citeulike:3980060, 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.}, author = {Tulsky, J. A.}, citeulike-article-id = {3980060}, citeulike-linkout-0 = {http://dx.doi.org/10.1001/jama.294.3.359}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16030281}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16030281}, day = {20}, doi = {10.1001/jama.294.3.359}, issn = {1538-3598}, journal = {JAMA : the journal of the American Medical Association}, keywords = {communication, end-of-life, skills, terminal}, month = {July}, number = {3}, pages = {359--365}, posted-at = {2009-01-29 23:18:21}, priority = {3}, title = {Beyond advance directives: importance of communication skills at the end of life.}, url = {http://dx.doi.org/10.1001/jama.294.3.359}, volume = {294}, year = {2005} }

TY - JOUR ID - citeulike:3980060 L3 - citeulike-article-id:3980060 N2 - 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. IS - 3 JF - JAMA : the journal of the American Medical Association SN - 1538-3598 EP - 365 TI - Beyond advance directives: importance of communication skills at the end of life. VL - 294 SP - 359 KW - communication KW - end-of-life KW - skills KW - terminal AU - Tulsky, JA PY - 2005/07/20/ UR - http://dx.doi.org/10.1001/jama.294.3.359 ER -