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Improving the quality of end-of-life discussions

Myers, Jeffa,b

Current Opinion in Supportive and Palliative Care: March 2015 - Volume 9 - Issue 1 - p 72–76
doi: 10.1097/SPC.0000000000000108
SUPPORTIVE CARE AND PSYCHOLOGICAL ISSUES AROUND CANCER: Edited by Elie Isenberg-Grzeda and Janet Ellis
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Purpose of review This article provides an update on the recent research and evidence regarding quality in end-of-life (EOL) discussions with a focus on the care of a person with cancer.

Recent findings Clinicians have the challenging task of customizing the information exchange that occurs during an EOL discussion. Patients identify important stipulations that accompany a desire for frank EOL discussions. These include timing of the discussion, ensuring evaluation of readiness to engage in the EOL discussion, and being invited to participate. The timing of an EOL discussion is likely to be more important than the setting in which an EOL discussion occurs. Less than 1 month prior to a person's death is likely to be an inadequate amount of time to allow a patient to consider and reflect on his or her EOL preferences. Among those admitted to the hospital, delay in the timing of EOL discussions carries the risk of losing decision-making capacity.

Summary There is greater use of quality metrics as patient outcomes among studies examining EOL discussions. System-wide approaches to improving EOL discussions should include standardized documentation templates that are widely accessible in electronic medical records.

aDivision of Palliative Care, University of Toronto

bSunnybrook Health Sciences Centre, Toronto, Ontario, Canada

Correspondence to Jeff Myers, MD, MSEd, Rm H336, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Tel: +1 416 480 6100 7255; e-mail: jeff.myers@sunnybrook.ca

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