Palliative Care

1. PALLIATIVE CARE
Enhancing Communication with
Patients and Families
Rama Kunkle, D.O.
Medical Director, Palliative Care Services
HonorHealth, John C. Lincoln Medical Center

2. What is Palliative Care?
Palliative Care: YOU Are a BRIDGE

3. Preparing for a Family Meeting
• Identify one clinician as meeting
leader
• Ensure team understands goals of
meeting
• Identify mpoa or surrogate decision
maker
• Arrange a private, quiet location with
seating for all

4. Starting the Meeting
• Have each person introduce
him/herself
• Ask family to give their sense of the
situation
• Start from where the family is

5. Giving Information
• Ask for permission
• Explain medical situation in simple
terms. Avoid jargon
• Don’t talk too much or focus on
technical matters
• Check frequently on what the family
has heard
• Be transparent about uncertainty

6. A Guide for Conducting a Family
Meeting: Empathy
• N-ame “you seem distressed, (or angry or
worried, etc.)”
• U-nderstand “this must be very difficult for
you”
• R-espect “You are asking a lot of very good
questions”
• S-upport “We can meet again tomorrow”
• E-xplore-“Tell me more about what you are
thinking/feeling”

7. Phrases to Avoid
• “There is nothing more we can do”
• “I wish there was something we could do to
make your lungs get better”
• “Would you like us to do everything
possible?”
• “How were you hoping you we could help
your mother?”
• “Withdrawal of care”
• “Stop the interventions that are no longer
helpful”

8. Wrapping Up the Meeting
• Ask for questions
• Arrange for a follow-up
• Summarize any decisions that were
made
• Document the meeting and plan in
the chart

9. Health Care Decisions
• If a patient can make his/her own
decisions, the patient should be
asked and their wishes should be
honored
• State of Arizona Surrogate list
1. Guardian
2. Health Care (Medical) Power of
Attorney

10. Surrogate List
• The patient’s spouse unless legally
separated
• An adult child of the patient, or a
majority of adult children
• A parent of the patient
• The patient’s domestic partner if the
patient is unmarried
• A brother or sister of the patient
• A close friend of the patient

11. Health Care Decisions
• If no one can be identified, the attending
physician can make a decision after
consulting with an ethics committee
• 2 physicians can make decisions
• Only the patient, a guardian or MPOA can
make the decision to withdraw the artificial
administration of food or fluid
• All other medical treatment decisions can
be made by the appropriate decision-
maker

12. Reference
• “A guide for conducting an ICU Family
Meeting When the Patient is Unable to
Participate.” Robert Arnold MD and Judith
Nelson, MD, JD