Below are two videos of Dr Gomez leading a discussion with Mr. Williams and his family regarding his far advanced lung cancer. Her goal in each of these family conferences is to initiate a palliative care discussion that moves the patient and family away from curative care and towards palliative/hospice care. Specifically, Mr. Williams has shared with Dr Gomez his wish to stop aggressive curative treatment and go home to live the best life he can with hospice support. He is worried his family isn’t ready to let go of life prolonging treatments and aren’t willing to care for him at home with hospice. He is too weak and ill to initiate this talk with his family alone and asks Dr. Gomez to facilitate this discussion for him. Dr Gomez agrees and is successful in achieving this goal in both videos, but she uses widely differing methods. Please observe each of the videos and reflect on the effects her two differing approaches have on Mr. Williams, his family, his nurse Lauren and Dr. Gomez.
In each video Dr Gomez used a varying set of concrete and observable behaviors to achieve the goal of moving from curative to palliative care. Whether with thoughtful intention or by unexamined habit Dr Gomez chose differing behaviors and patterns of organization to conduct these two discussions. From an educational perspective she used two different “models” for discussing the transition from curative to palliative care. However the two approaches had significant and differing affects on the outcomes of the encounter for the patient, family and clinicians. What were the observable behaviors that Dr Gomez used in each encounter and how did they differ? Which behaviors promoted the shift to and provision of palliative care and which behaviors hindered this transition? If you had been in the room with Dr Gomez how would you coherently discuss with her what she did and why? In the following four modules you will explore answers to these questions and many more as you explore the attitudes, knowledge and skills needed to provide optimal palliative and end-of-life care to the patients and families you will serve.
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