Palliative care is recognized as a way to improve the quality of life and satisfaction of patients and their families, and even to optimize the use of health care services. However, it is implemented too little and too late for people with advanced chronic illnesses – and even more so for those suffering from non-cancer diseases. One of the main reasons for this is the “prognostic paralysis” that physicians face. Progressive chronic illnesses actually tend to have unpredictable trajectories, making it uncertain when the time is right to initiate end-of-life discussions. Various tools are available to help general practitioners identify patients who would benefit from a palliative approach, initiate such discussions, and assess potential unmet needs. Other tools exist to guide highly emotional conversations, to which physicians should add communication training to acquire the skills necessary to lead these complex discussions.
What is already known about the topic?
Early palliative care improves the quality of life and satisfaction of people with advanced chronic illness(es) and their families, and has the potential to optimize the use of health care services. However, it is initiated too infrequently and too late, in the very last days of life.
What does this article bring up for us?
This article recalls the particular context of end-of-life care for the older people, discusses the right time to broach end-of-life issues with them, and provides some tips for managing highly emotional conversations.
Keywords
Palliative care, advance care planning, older people, screening, communication