Discussions about procedures and code status:
- Decision makers hear options presented as reasonable, even when we specifically say something is an option but not a reasonable thing to do
- They actually have minimal interest (usually) in the specifics of the procedure (chest compressions, broken ribs, etc). What they really want to know when they ask “what does that mean” is how does X procedure fit with goals of cares
- The want the medical provider to make a recommendation
When discussing procedures:
- Talk about risks and outcomes in relation to the goals of care
- Incomplete recovery? Prolonged death? Uncomfortable test?
- Only discuss the details of the procedure in big-picture terms. The decision-makers will usually ask for more specific detail if desired
- Make a recommendation!!
When working with clients who refuse/don’t believe in euthanasia or withdrawal of care:
Do…
- Introduce yourself & give information that you have reviewed the case
- Ask: “what is your understanding of your pet’s illness, and quality of life?”
- Ask: “what are you hoping we can do/achieve for your pet?”
- Ask: what is the owner(s) most afraid of?
- Ask: if your pet were to die tomorrow, what would you want us to accomplish before that?
Don’t…
- Argue
- Power struggle
Never leave families with a sense that they have been told “there’s nothing we can do.” There may not be a cure for the patient but we can almost always do things to improve comfort, relieve symptoms, or at the end take away awareness of suffering.
When working with clients who “Don’t believe you” and are “waiting for a miracle”, try the AMEN framework (works with many other situations too):
- A = Affirm
- People who have had a discussion about their faith/had their faith affirmed are less likely to pursue futile therapies
- “We also hope that you get a miracle. We also hope that your pet lives.” “We will celebrate with you…”
- “What are some things that we can do that, if the miracle doesn’t come, you will have no regrets?”
- M = Meet people where they are
- Recognize where the person is in the process of their pet’s disease/death
- When they want to explore options – do it!!
- Time and space to come to realization that everything that can be done, has
- E = Educate
- Don’t move from your professional opinion
- Maintain stance on disease, team together on same page
- Don’t work against beliefs, work with their beliefs
- N = No matter what we are fully committed to you/your pet
- If people lose the sense that you are committed to them and their pet they will pursue futility longer
Some useful links:
Palliative Care Network of Wisconsin (check out the Fast Facts in particular)
