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12 - When You’re Really Stuck

Tracking the Talk … and Adjusting

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
Affiliation:
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
Affiliation:
University of Washington Medical Center
Elise C. Carey
Affiliation:
Mayo Clinic, Minnesota
James A. Tulsky
Affiliation:
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Affiliation:
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Affiliation:
Scripps Health, San Diego, California
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Summary

Some situations are particularly challenging. These include high-stakes, high-emotion conversations, like when patients talk about miracles or when they request hastened death. In the case of miracles, it is because they understand how bad things are that miracles are invoked. In the case of requests for hastened death, the request is brought on by suffering or fear of suffering. In both cases, the first thing is to do is take a breath and then explore, rather than react from a place of emotion. Another challenge is when responding to emotion isn’t enough. This can occur when a patient really does want information, when patients are coping through intellectualizing, when the emotion is too overwhelming, or when the level of emotion (and sometimes physical agitation) is elevated to the point of feeling or being unsafe. Each of these requires a tailored response like giving information, nonconfrontation, or containment before being able to move forward. Finally, in situations when our own emotions become elevated, it is important to allow ourselves to feel while being mindful we remain of service to the patient, and that we get support from trusted team members and colleagues.

Type
Chapter
Information
Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 185 - 195
Publisher: Cambridge University Press
Print publication year: 2024

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References

Further Reading

Back, A. L. and Arnold, R. M., “Isn’t there anything more you can do?”: When empathic statements work, and when they don’t. J Palliat Med, 2013, 16(11): 1429–32.CrossRefGoogle ScholarPubMed
Cooper, R. S., Ferguson, A., Bodurtha, J. N., and Smith, T. J., AMEN in challenging conversations: Bridging the gaps between faith, hope, and medicine. J Oncol Pract 2014, 10(4): e191–5.CrossRefGoogle ScholarPubMed
Posluszny, D. and Arnold, R. M., Managing one’s emotions as a clinician. J Palliat Med, 2009, 12(10): 955–6.CrossRefGoogle ScholarPubMed
Quill, T. E., Back, A. L., and Block, S. D., Responding to patients requesting physician-assisted death: Physician involvement at the very end of life. JAMA, 2016, 315(3): 245–6.Google ScholarPubMed
Widera, E. W., Rosenfeld, K. E., Fromme, E. K., Sulmasy, D. P., and Arnold, R. M., Approaching patients and family members who hope for a miracle. J Pain Symptom Manage, 2011, 42(1): 119–25.CrossRefGoogle ScholarPubMed

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