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• W2074806761 abstract "New York recently became the second state in the nation to enact legislation that requires physicians to offer terminally ill patients an opportunity to discuss end-of-life options. The Palliative Care Information Act, which went into effect on February 9, 2011, mandates that New York attending doctors and nurse practitioners offer terminally ill patients information and counseling on palliative care and appropriate end-of-life options. The law expects that patients will be provided with information about their prognosis, the risks and benefits of the various treatment options, and the right to comprehensive pain and symptom management, including palliative sedation for refractory suffering. Advocates of the legislation see this as a progressive step to enhance patient and family decision making by providing information about choices at the end of life. Opponents of the legislation, like the Medical Society of the State of New York, worry that it will interfere with the physician-patient relationship, and that each physician should decide how much information to disclose. That we need a law in the first place to instruct clinicians to provide what most people say they would want if faced with a life-limiting illness—honest and accurate information about their disease and its treatment—is disconcerting. However, as New York teaching hospitals are ranked near the bottom nationally in usage of hospice care for cancer patients at the end of life, a state mandate seemed appropriate.1Goodman DC, Fisher ES, Chang CH, et al. Quality of end-of-life cancer care for Medicare beneficiaries: Regional and hospital-specific analyses. A report of the Dartmouth Atlas Project. 2010. Available from http://www.dartmouthatlas.org/downloads/reports/Cancer_report_11_16_10.pdf.Google Scholar Although the legislation provides the necessary legal basis to improve end-of-life communication, it is not sufficient to change health care providers’ practices. What is missing is direct guidance and educational interventions to improve the very way clinicians discuss prognosis and options for the terminally ill. Health care professionals do not inherently know how to communicate well with patients and grieving family and receive little training to help them cope well with discussions about death and dying. However, medical educators and academic palliative care specialists do know how to teach these skills. Physicians and other key medical personnel can be taught about active listening; encouraging questioning and the creation of options; “leveling the playing field” to reduce the power differential among patient, family and provider; and ferreting out cultural and family patterns of discourse that interfere with consideration of medical developments. There is mounting evidence and experience suggesting that clinicians can refine their communication skills and optimize patient preferences when properly trained and mentored.2Back A.L. Arnold R.M. Tulsky J.A. Baile W.F. Edwards K. “Could I add something?”: teaching communication by intervening in real time during a clinical encounter.Acad Med. 2010; 85: 1048-1051Crossref PubMed Scopus (20) Google Scholar, 3Back A.L. Arnold R.M. Baile W.F. et al.Faculty development to change the paradigm of communication skills teaching in oncology.J Clin Oncol. 2009; 27: 1137-1141Crossref PubMed Scopus (92) Google Scholar, 4Back A.L. Arnold R.M. Tulsky J.A. Baile W.F. Fryer-Edwards K.A. Teaching communication skills to medical oncology fellows.J Clin Oncol. 2003; 21: 2433-2436Crossref PubMed Scopus (210) Google Scholar, 5Bylund C.L. Brown R.F. di Ciccone B.L. et al.Training faculty to facilitate communication skills training: development and evaluation of a workshop.Patient Educ Couns. 2008; 70: 430-436Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar, 6Yedidia M.J. Transforming doctor-patient relationships to promote patient-centered care: lessons from palliative care.J Pain Symptom Manage. 2007; 33: 40-57Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Should hospitals fail to develop proactive policies and educational interventions that both comport with state legal policy and with well-accepted practices of truthful disclosure, then we may witness reactive policies develop in response to concerns over medical liability. Indeed, one implication of the law is that it may lead to malpractice claims when physicians are believed to inadequately disclose the full spectrum of palliative care options to their terminally ill patients. Currently, in the state of California, the family of Michelle Hargett Beebee is alleging that not being informed about palliative sedation for her severe cancer pain at the end of her life violated the state’s Right to Know End-of-Life Options Act (Hargett v. Vitas). If similar malpractice cases occur in New York as a result of the Palliative Care Information Act, we can expect to see institutional measures implemented to protect hospital liability, an outcome that may be far from the goal of promoting patient autonomy and improving medical practice. Individual hospitals and health care facilities, with guidance from palliative care experts and clinical ethics consultants, should take the initiative in the creation of appropriate communication training programs to enhance clinician comfort around discussing end-of-life options with patients. Examples of such programs include communication skills workshops, objective structured clinical examination, learning blogs, simulation programs, and other systems to support the development of language, facilitation and mediation skills to enable all clinicians to provide optimal care and options to those at the end of their lives. We believe that such proactive approaches will be far more likely to enable the health care provider, together with the patient and family, to develop a plan of care at the end of life that will maximize comfort and minimize pain and suffering. We hope the new law will inspire system-based approaches to enhance clinician communication skills in New York hospitals. Such interventions can then be analyzed to determine efficacy and set a new standard for communication training." @default.
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• W2074806761 title "The Right to Information—A First Step Toward Improving End-of-Life Care" @default.
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