title: The patient-physician relationship. Ensuring competency in end-of-life care: communication and relational skills.
abstract: Physician competence in end-of-life care requires skill in communication, decision making, and building relationships, yet these skills were not taught to the majority of physicians during their training. This article presents a 7-step approach for physicians for structuring communication regarding care at the end of life. Physicians should prepare for discussions by confirming medical facts and establishing an appropriate environment; establish what the patient (and family) knows by using open-ended questions; determine how information is to be handled at the beginning of the patient-physician relationship; deliver the information in a sensitive but straightforward manner; respond to emotions of the patients, parents, and families; establish goals for care and treatment priorities when possible; and establish an overall plan. These 7 steps can be used in situations such as breaking bad news, setting treatment goals, advance care planning, withholding or withdrawing therapy, making decisions in sudden life-threatening illness, resolving conflict around medical futility, responding to a request for physician-assisted suicide, and guiding patients and families through the last hours of living and early stages after death. Effective application as part of core end-of-life care competencies is likely to improve patients' and families' experiences of care. It may also enhance physicians' professional fulfillment from satisfactory relationships with their patients and patients' families.
authors: Interdisciplinary Program on Professionalism and Human Rights, 750 N Lake Shore Dr, Suite 601, Chicago, IL 60611-2611, USA.
authors: C F
authors: CF
authors: von Gunten
authors: F D
authors: FD
authors: Ferris
authors: L L
authors: LL
authors: Emanuel
mesh_terms: D032722:Advance Care Planning; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D005066:Euthanasia, Passive; D006117:Grief; D006801:Humans; D018447:Medical Futility; D010347:Patient Care Planning; D010819:Physician's Role; D010817:Physician-Patient Relations; D017236:Suicide, Assisted; D013727:Terminal Care