Fast Fact and Concept #042: Broaching the Topic of a Palliative Care Consultation
2nd EditionAuthor(s): Robert Arnold, MD and David E. Weissman, MD
Palliative care consultative services are becoming commonplace in academic and community hospitals. Patients and families
often, although not always, have negative perceptions of palliative care and hospice, viewing such a discussion as signaling
that the physician is giving up on the patient and that the reality of impending death must be faced. For the attending physician,
the decision to convey to a patient and family that a consultation is needed can provoke anxiety; physicians may fear such
a discussion will provoke anxiety, anger or a sense of hopelessness. This Fast Fact provides tips for beginning a discussion
leading to a visit by a palliative care consultation team.
First, decide why you want assistance from the palliative care team; typically, physicians seek assistance in four domains:
1) pain and non-pain symptom assessment and management; 2) assistance in making difficult decisions, usually about continued
use or withdrawal of technological treatments such as feeding tubes, antibiotics, dialysis, or ventilators; 3) assistance
in planning for the most appropriate care setting and care givers to meet patient/family goals for end-of-life care; and 4)
providing psychological support to patients, families and the health care team.
Second, contact the palliative care team; discuss your reason(s) for consultation along with pertinent details of the patient’s
history and family support structure. Describe both what your goals are for the consultation, as well as what the family’s/patient’s
goals may be. This is a good time to discuss any concerns you have about using the term palliative care with the patient or family.
Third, engage the patient/family in a discussion of the current medical condition and goals of care. (see FF # 38 Discussing Hospice Care). Introduce the topic of a consultation by saying: To best meet some of the goals we've been discussing (fill in with the goals mentioned by the family/patient) I'd like to have some consultants from the Palliative Care Team visit with you. You can follow this by saying, They are experts in treating the symptoms you are experiencing (fill in symptom); They are also good at helping your family deal with all the changes brought on by your illness; they can answer your questions
about (fill in previously discussed patient questions).
You should not say that the reason you are asking Palliative care to be involved is that there is nothing more to do or because
I have nothing more to offer. Talk about the positive goals Palliative care can help you and the patient achieve.
Finally, emphasize your continued involvement: You and I will talk about the recommendations of the palliative care experts. I'll make sure all your questions are answered. This can help relieve fears of abandonment. If a patient or family reacts negatively to the suggestion for a consultation,
you might explore their concerns. Someone may have mentioned palliative care and this may have negative connotations to them.
Ask, What experience do you have with hospice/palliative care? What are your concerns? It may be important to discuss that palliative care is compatible with aggressively treating the underlying disease. Emphasize
the positive aspects of what palliative care can do, rather than focusing on how the palliative care team will help them accept
death and dying. After all, the goal of palliative care is to achieve the best possible quality of life through relief of
suffering, control of symptoms and restoration of functional capacity, while remaining sensitive to the patient and family's
value. Palliative care guides the patient and family as they face disease progression and changing goals of care, and helps
those who wish to address issues of life completion and life closure.
References
Weissman , DE . Consultation in Palliative Medicine. Archives in Internal Medicine. 1997: 157:733-737.
Precepts of Palliative Care. Last Acts Campaign Task Force on Palliative Care. J Pall Med 1998; 1; 109-115
Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007. For
comments/questions write to the current editor, Drew Rosielle MD : drosiell@mcw.edu . The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu
Copyright/Referencing Information : Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Arnold R
and Weissman DE . Broaching the topic of a Paliative Care Consultation with patients and families. Fast Fact and Concept #42
2nd Edition, July 2005. End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu .
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise
their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication,
or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should
be consulted before any such product is used.
Creation Date: 5/2001; 2nd Edition, July 2005.
Purpose: Self-Study Guide, Teaching
Audience(s)
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Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
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Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology,
OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
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Non-Physician: Clergy/Chaplains, Nurses, Social Workers
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ACGME Competencies: Interpersonal and Communication Skills, Patient Care, System-based Practice
Keyword(s): Caring for families, Negotiating treatment goals
