title: The importance of patient-provider communication in end-of-life care.
abstract: Successful formulation and implementation of end-of-life care requires ongoing communication with the patient. When patients, for reasons of general medical or psychiatric illness, fail to verbally communicate, providers must be receptive to messages conveyed through alternate avenues of communication. We present the narrative of a man with schizophrenia who wished to forgo hemodialysis as a study in the ethical importance of attention to nonverbal communication. A multilayered understanding of the patient, as may be provided by both behavioral and motivational models, can inform the provider's ability to receive, process, and represent communicated content to the patient or his or her surrogate decision-maker.
authors.affiliation: Department of Psychiatry, The Mount Sinai Medical Center, Box 1230, 1425 Madison Avenue, New York, NY 10029, USA. timothy.rice@mssm.edu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Rice
authors.forename: Yuriy
authors.initials: Y
authors.lastname: Dobry
authors.forename: Vladan
authors.initials: V
authors.lastname: Novakovic
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Appel
mesh_terms: D006801:Humans; D007389:Internal-External Control; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010166:Palliative Care / Q000941:ethics*; D011369:Professional-Patient Relations / Q000941:ethics*; D006435:Renal Dialysis; D012559:Schizophrenia; D020458:Third-Party Consent / Q000941:ethics; D016312:Treatment Refusal / Q000941:ethics*