April 2019 – When you would not be surprised if your patient died in the next year, it is time to take action to provide care that makes medical sense and is aligned with realistic patient goals.
1. Try to improve prognostic awareness. “In my experience, patients with your condition begin to have more trouble with . . .”
2. Begin to de-prescribe. “We are in a different place now . . .” is a good lead-in to why tight blood pressure and blood sugar control may be more harmful than helpful now.
3. Ask what is most important to the patient’s quality of life and try to keep that the focus of your care.
4. Complete Health Care DPOA paperwork. Encourage HC-DPOA to attend appointments. Complete a POLST form together after you have listened to the patient’s goals.
5. Consider a referral to hospice for an informational visit as part of advance care planning. “At some point, having care come to you in your home may be best. Hospice is a way to make that happen.”
Use compassion and non-abandonment:
“I wish I could turn things around. . .”
“I will help you through this.”