Dealing with Death & Dying in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS Email:griefdoc@kirstimd.com
AMSA Convention March 30, 2001
Questions to Improve Discussions of End-of-Life Care

Questions for Family Members

  • What is your understanding of what is going on?
  • Why have you decided to _______________?
  • What are you hoping we can accomplish/achieve?
  • What do you think __________ would want us to accomplish for him/her?
  • What else would he/she want us to accomplish?
  • Which of these goals are the most important?
  • In what situations, if any, could imagine ______ not wanting to continue to live?
  • Are you questions getting answered?
  • Do you have concerns about the care your loved one is getting?
  • Do family members disagree on certain issues?
Questions to Ask Yourself
  • What do I think are this patientís chances of surviving to discharge/recovering function?
  • What have I told the patient/family regarding his/her chances of surviving to discharge/recovering function?
  • How sure am I about his/her prognosis? On what is the prognosis based?
  • What do I know about what this patient wants (or would have wanted)? How do I know? How sure am I?
  • Is this patient competent to make his/her own decisions? How do I know? How sure am I? Could it be fluctuating or reversible incompetence?  
  • Did I/we contribute to a bad outcome in any way (missed diagnosis, delayed tx.)?
  • How do I feel about discussing this patientís death with him/her (his/her family)?
  • Who are this patientís physicians? Clergy of choice? Nurse? Social Worker?
  • Do I feel I have enough time to talk to the patient/family about prognosis, options and goals?
  • What words or phrase have others or I used that might be contributing to conflict between family members? Could I use "change to pallative care" and "change what we are hoping for" instead of "stopping treatment" and "comfort measures only"?
  • What aspects of this patients life do I feel justified withholding or withdrawing life-sustaining treatment?
  • Does the family trust us? If not, why?
Source
Goold SD, Williams B, Arnold RM. Conflicts regarding decisions to limit treatment: A differential diagnosis. JAMA 2000;283:909-914.

Compilation of resources for this presentation © 2001 Kirsti A. Dyer, MD, MS. Journey of Hearts, www.journeyofhearts.org