Palliative Care Planning

In this third entry on the Use of Oral Oncolytics in Palliative Care, part of the Oncology Stakeholders Summit, Spring 2015 series, Bruce A. Feinberg, DO, and Brian B. Kiss, MD, address issues in introducing the palliative care plan to the patient and the family.

Dr Kiss, vice president, healthcare transformation, Blue Cross Blue Shield of Florida, believes it is critical that the patient’s family be involved in palliative care decisions, and they try to fully understand and come to terms with their relative’s priorities. As many patients do not usually discuss their wishes at the end of life, Dr Kiss believes that their desires should be made clear early on to everyone involved.

With regard to physicians’ having palliative care discussions with their patients, Dr Feinberg states that it can very difficult for clinicians to have these end-of-life conversations in the office, perhaps after just showing the patient a CT scan of his or her advancing disease and under the practice’s time pressures. The vice president and chief medical officer at Cardinal Health Specialty Solutions describes the need to have the right physician or “a licensed clinical social worker certified in palliative care counseling spend 90 minutes having that conversation, with the family present.” Explaining the patient’s options at the appropriate time, and spending the time needed to thoroughly discuss these options, is extremely important, with other friends or family members on hand to lend support.

Perhaps clinicians should have 2 separate end-of-life conversations, according to Dr Kiss. First, one with the patient, to allow him or her to formulate ideas about what to do. Then, a second conversation with the family after the patient has had time to consider his or her own options.