End-of-life care: how are decisions made?

Summary

Dr. Rob Fowler, a Critical Care and General Internal Medicine Physician at Sunnybrook Hospital, discusses the hospital's policy on end-of-life care. The policy focuses on respecting patients' wishes, balancing aggressive treatments with comfort care, and helping families understand the limits of medical interventions. While the goal is always recovery, there are times when recovery is not possible. In such cases, the aim is to ensure the patient is comfortable, pain-free, and at peace, while providing support to both patients and families during this difficult time.

Takeaways

• 🩺 End-of-life care policy at Sunnybrook Hospital is designed to provide the best care for patients in their final stages of life.
• 👥 The policy was created through collaboration among physicians, nurses, spiritual leaders, and allied healthcare professionals.
• 💬 Treatment decisions are based on the patient's wishes, or, if the patient is unable to communicate, on what their family or substitute decision makers believe they would want.
• ⚖️ The goal is to balance aggressive medical interventions with ensuring patient comfort, particularly when a cure is not possible.
• 🛏️ Life-sustaining treatments like ventilators, intravenous medications, and dialysis may keep organs functioning, but not necessarily improve the patient's overall condition or quality of life.
• ❤️ At times, healthcare professionals must help families understand when medical efforts can no longer improve a patient's condition, leading to a focus on comfort rather than cure.
• 🚑 CPR within a hospital setting, especially for very ill patients, is often less effective than how it’s portrayed on television.
• ⚠️ The process of CPR can be painful and may leave patients in worse conditions than before, contrary to the common belief that it always revives patients.
• 🕊️ The aim of end-of-life care is to help patients, regardless of their age or condition, transition through the final phase of life as comfortably as possible.
• 🌿 While curative treatments may not always be available, efforts are made to provide comfort and dignity during a patient's final moments, striving for a 'good death.'

Q & A

What is the main focus of the policy at Sunnybrook Hospital discussed by Dr. Rob Fowler?

The main focus of the policy is to provide the best possible care for patients at the end of life, ensuring that their wishes are respected while balancing the limitations of medical treatments.

Who contributed to developing the end-of-life care policy at Sunnybrook Hospital?

The policy was developed by a multidisciplinary team, including physicians, nurses, spiritual leaders, and allied healthcare professionals.

Why is it important to have an appropriate care plan for end-of-life patients?

An appropriate care plan ensures that the patient's wishes are respected and that the care provided aligns with their values, focusing on both treatment limitations and comfort.

What does the healthcare team do if the patient is unable to communicate their wishes?

If the patient cannot communicate, the healthcare team consults with the family or substitute decision-makers to determine the patient's wishes based on prior conversations and known preferences.

What is one of the challenges in providing end-of-life care in the intensive care unit (ICU)?

A challenge is balancing aggressive medical interventions, such as ventilators or dialysis, with the need to keep patients comfortable, especially when there is little hope of recovery.

How does Dr. Rob Fowler describe the effectiveness of CPR in a hospital setting for critically ill patients?

Dr. Fowler explains that CPR is often less effective in a hospital setting for critically ill patients compared to what is portrayed on television, and it may lead to worse outcomes or additional discomfort.

What is the difference between real-life CPR outcomes and those shown on television, according to Dr. Fowler?

On television, CPR is often shown as highly effective, with patients recovering and leaving the hospital, whereas in real life, CPR in critically ill patients is less likely to be successful and may not improve their condition.

What role does comfort play in the treatment of end-of-life patients?

Comfort is a primary goal when curative treatments are no longer possible. The healthcare team focuses on reducing pain, anxiety, and suffering to ensure a peaceful and comfortable end-of-life experience.

What is the healthcare team’s responsibility when aggressive treatments no longer improve a patient’s overall condition?

The team’s responsibility is to help the patient and family understand that medical interventions may only support organ function without improving the overall quality of life, prompting discussions about comfort-focused care.

What is the ultimate goal of the end-of-life care policy at Sunnybrook Hospital?

The ultimate goal is to ensure that patients have as comfortable an end-of-life experience as possible, providing medical care to reverse treatable conditions while also prioritizing comfort when cure is not achievable.