Using the Morbidity and Mortality Conference Model to Explore and Improve Community-Based Oncology Care (Video Program)Effect of short-term goals on a patient’s will to live
2:47 minutes.
TRANSCRIPTION:
DR LOVE: We asked in the survey, did the patient have any short-term goals that they were pointing towards that you were trying to help them move towards, a classic situation that’s described in oncology? You have a patient who maybe has a projected limited life expectancy. They have an upcoming graduation, a birthday, a birth, and they focus on that. And trying to get to that event, hopefully in good health, becomes an important goal. And we did see that in many of these cases, the physicians were aware that the patients had goals. And they described them. And they were kind of a lot what you might expect, but it was interesting, reading through those. I don't know if you saw the one about — there was no explanation, but it just said, “Attended the funeral of my ex.” Did you see that one? DR BIRRER: I did. Talk about relieving stress! DR LOVE: Yes. I was trying to decide, does that mean maybe they got back together and they were friends, or — but then why would they be so intent to go to the funeral? But, anyhow, I was just curious what your thoughts were reading that. DR BIRRER: Well, I think it’s an interesting question. And it comes up much more frequently than I think a lot of people are aware of. In my own practice, that question and those kinds of conversations obviously don’t occur early on, because patients are more focused on getting over the initial presentation of the disease. And there’s anticipation that, if there’s not a cure, there’s going to be a long survival. So these issues come up later on in the natural history of the disease, when there’s certainly beginning to be a recognition that this may be a fatal disease. And there are two ways to approach those patients. One is, I do spend a lot of time talking about new therapies, new agents — and this is where trial comes in — which provides a lot of hope for patients. And hope is such a huge factor in terms of survival, an issue that I think palliative care people play on, too. The second component is what you’re pointing out, what was in this survey, which is if patients can focus on a pleasant event, something that’s important for them, it’s almost a metaphysical issue, which is, “Okay. Lookit. If I want it bad enough, I’ll live that long. It doesn’t really matter what Dr Birrer does with my chemo, I’m going to live that long.” And I, without exception, support that, unless it’s completely unrealistic, which is usually not the case. |