Hola a tod@s, my dear friends.
“How to respond to an ICU patient asking if she/he is going to die”: this is the title of the article published by Margaret Isaac and J. Randall Curtis online first last September in Intensive Care Medicine, as “What´s New in Intensive Care?”.
It is not easy at all to establish direct talks in this sense with our patients. The question “Doctor, am I going to die?” can be deeply uncomfortable for physicians.
In this process we must confront our own fears, even to contemplate our own death. In addition of breaking bad news, doctors often struggle with the balance between hope and uncertainty facing the truth.
The basic principles of patient-centered communication can guide clinicians in their responses to such questions and will help us to obtain the perspective of the patient and his/her disease, inquire about their concerns and recognize and explore the emotions.
The question “Am I going to die?” may be a reflection of other hopes and fears. It can be an expression of fear, pain and physical suffering, anticipated shame by the loss of loved ones or the existential and spiritual anguish faced by the unknown and the totality of life.
Exploring patient’s perspective is essential to ensure that clinicians are going to manage adequately these specific concerns. It is easy to treat physical symptoms, but the existential and spiritual distress can be a difficult task for many of us when a patient is in the process of dying. Even many doctors think that this exceeds their clinical practice.
Questions such us “Tell me more about what you think is going on right now” or “What fears do you have right now?” can be helpful. Also we can speak with the family or loved ones, or even we could find support from psychologists or priest.
Not all patients want explicit pronostic information. But the question “Am I going to die?” might suggest us that a person is opening the door to a frank conversation. And if we are going to talk about prognosis, the conversation must be structured in specific terms, avoiding vague language.
We have to recognize and validate the emotions of the patients, a step ignored in the communication many times. This is so important as transmit security and non abandonment, without promising impossible results. And articulate an effective communication during all the process, even if the patient survives to the ICU.
For this, the article offers a table with “the 5 Ps stragegy of discussiong a poor prognosis”: Perspective, Prior experiences/context, Permission, Prognosis and Provision of support.
This is a great field for improvement, isn´t it?