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Healthy Outlook

Palliative Care Can Help Us Prepare for Death on Our Own Terms

By Dr. Stephanie Cheng

Thursday, May 28, 2015

Recently I had a patient whose diagnosis was grim – cancer not likely to be cured, and probably terminal within a matter of months.

But, despite the prognosis, there were still ways we could help.

Medical therapy is almost always associated with finding a cure. However, when an illness cannot be cured, it does not mean that a patient cannot experience healing. Palliative care is a medical specialty that focuses on relieving a patient's symptoms and stress from a serious or chronic illness, especially when a cure is not possible.

Palliative care can be appropriate at any age and at any stage of a serious illness, and can be provided along with curative treatment.

The palliative team addresses practical, emotional and spiritual issues inherent in facing ongoing illness and possible death, and ultimately it works to increase the quality of life of the patient and their family members. In this patient's case, we helped make an uncomfortable conversation easier about end-of-life care.

Discussing death and end-of-life care with loved ones and healthcare providers in advance can ensure that our preferences are honored and that care is delivered in the most personalized, respectful and effective way.

For example, do you want a breathing tube and mechanical ventilation if you cannot breathe on your own? If your heart stops beating, would you want chest compressions? Who would you like to be present during your final moments? Is staying at home a priority for you? By taking the time now to make our own end-of-life decisions, even if difficult, we actually can empower ourselves.

These can be difficult subjects, and when facing death, it can be even harder to know where to start a discussion. But there are plenty of good resources, even if you are not in need of palliative care.

Deathoverdinner.org and theconversationproject.org are two easy-to-use web sites that can guide you step by step through conversations with loved ones, colleagues or anyone else in your life.

Your physician can also be a wonderful resource. As a family physician, I invite my patients to share information about their lives, whether they are facing life-threatening illnesses or are well.

On a practical level, there are also ways to leave written instructions for both the family and medical team. The Physicians Orders for Life Sustaining Treatments (POLST) form allows the patient to express specific wishes regarding life-sustaining treatment.

There are also legal documents, known as advance directives or living wills, which specify the actions that should be taken if a patient is no longer able to make decisions for themselves.

By completing a POLST or advance directive, your loved ones can better advocate for you. Nothing is black or white in medicine, but documented preferences can help guide patient care and allow your medical team to better honor your wishes.

My patient with cancer appreciated the treatment options available through palliative care – choosing a referral to hospice care – and the family appreciated the assistance getting its affairs in order.

Two things are certain in life: the inevitability of death and our inability to know the when and how of it. When we take the time to think about our preferences for when the time comes, ultimately it can provide great comfort for both us and our loved ones.

Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at theairdoctor@gmail.com. For more health information, go to www.cchealth.org.
About the Author

Dr. Cheng is a family medicine resident at Contra Costa Regional Medical Center in Martinez.