Starting the End-of-Life Conversation

Try to understand who the person-your patient-is and what their values are, so that you can understand better how to treat them.

What to Ask: “What is more important to you, quality of life or quantity of life?” “Who do you want to make decisions for you in the event that you cannot make them?” “What values are most important for me to be aware of as we engage in this challenge of treating your cancer together?”

Establish a human connection with the patient-establish that you are in the same ‘existential boat’ with the person.

What to Ask: “What’s really important to you?” “What are the things in your life that give it meaning?” “What are the important relationships and activities?” “What’s most important for you to preserve?”

Don’t wait until the patient has very advanced disease to start the conversation; start it when you begin the treatment process.

What to Convey: “You’ve got cancer. Treating cancer is a serious issue. It’s often a life-and-death issue. If I’m going to care for you-if we’re going to go through this life-and-death issue together-I should know who you are as a person.”

Try not to fear the subject of death.

What to Ask: “What impact do you think this cancer will have on the length of your life?” “How long do you expect to live?” “Do you have concerns about death?”

Successful end-of-life care discussions do not happen in one session.

This is a process-don’t try to jam everything into one session. The conversation has to start early and continue throughout treatment; transitions will precipitate the need for further discussion.