Who is Responsible for Discussing End-of-Life Treatment Options? - page 3

Who is responsible for discussing end-of-life treatment options with the patient.......the physician? The nurse? In most instances it is the physician's responsibility to initiate discussion and... Read More

  1. by   MN-Nurse
    "
    easy 2 word answer:
    the doctor (in conjunction with patient, and/or family/guardian or poa).
    simple"

    if only the real world were so simple.

    in reality we are all responsible for addressing this need.
  2. by   leslie :-D
    one of my most eye-opening experiences as a nursing student, was when i was assigned a pt w/advanced ovarian ca.
    her pcp wanted her discharged to home and receive hospice services.
    her onc wanted her continuing aggressive tx.
    the family members looked like they were watching a tennis match betw the opposing dr's.
    the pt totally gave up in trying to express personal wishes, totally overcome by differing views.

    i found the whole scenario a disgrace.
    there was absolutely no team work whatsoever.
    ultimately, family agreed to further treatment.
    before initiating a new chemo agent, pt given 'fluid challenge' to see if kidneys would tolerate.
    they didn't and she died.
    this all happened in the course of the 6 wks i had her.

    during this time, i had become 'close' w/pt and family.
    pt expressed her desire to just go home but if family wanted her to continue w/tx, she would defer to their wishes.
    (actually, there are a lot of pts like this.)
    i shared pt's wishes with family.
    dtr pleaded w/mom, to try just "one more time"...
    of course pt agreed...and as stated, died in hospital.

    what the heck do you do when doctors disagree so openly and vehemently?
    this oncologist was psychologically exploiting family's vulnerabilities and indecisiveness.
    it was just plain wrong, in so many ways.

    it was that particular pt that i knew i had to try and ensure pts died the way they wanted to.
    the rest is history.

    leslie

    eta: this was a teaching hospital...which explains many of the futile txs given to pts...
    all in the name of a clinical opportunity for some overly enthused student.
    Last edit by leslie :-D on Jan 1, '12
  3. by   anotherone
    the whole thing is a disgrace. the doctor, any of them, should initiate it. they certainly know more than I do about treatments, prognosis, diagnosis etc. ( maybe some of you are more knowledgeable i am not...) Like another poster said, the patient first has to know they have a possibly terminal condition. I have seen many patients who don't even know that! The doctors all turf the responsibility of telling the patient onto another doctor or don't even discuss the topic. Some doctors are great at getting palliative medicine involved others no so great.
  4. by   tnbutterfly
    Quote from anotherone
    the whole thing is a disgrace. the doctor, any of them, should initiate it. they certainly know more than I do about treatments, prognosis, diagnosis etc. ( maybe some of you are more knowledgeable i am not...) Like another poster said, the patient first has to know they have a possibly terminal condition. I have seen many patients who don't even know that! The doctors all turf the responsibility of telling the patient onto another doctor or don't even discuss the topic. Some doctors are great at getting palliative medicine involved others no so great.
    Totally agree with this. The doctor should initiate the discussion.......but so many times it gets ignored until the patient is on death's doorstep.
  5. by   carolmaccas66
    I don't know re other countries, but I should clarify that RNs in Australia must have the primary doctor talk to the family first; it's a legal and ethical requirement. On hospice units, the doctor must see the family first before we go into any details re treatment or lack thereof.
    We are not allowed to discuss end of life decisions with the family otherwise, though we can give information after the doctor has seen them, and scribed in the notes re DNR status or whatever.
    My apologies for not making this clear.

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