When patients & families request that “everything” be done
- Understand what “everything” means
- ”Every treatment with even the slightest possibility of benefit” (rare)
- “Everything that you, as my physician, feel is worthwhile"
- "Everything to relieve symptoms, even though it may shorten life”
- Communicate prognosis
- Use clear & direct language (“Your mother is dying”)
- Maintain consistent messaging
- Avoid discussing minutiae of management
- Propose a philosophy of treatment
- Offer medical recommendations with appropriate limits to therapy
- Discuss what will be done before covering what will not be done
- Illustrate how the recommendations support the patient’s values
- Support emotional response
- Validate emotions & invite conversation (“What is the toughest part of this for you?“)
- Reaffirm commitment to caring for the patient no matter what happens
- Negotiate disagreements
- Review understanding & seek common ground
- Seek external input for persistent, unresolved conflict (eg, from ethics committee)