Clinical Progress Note: Addressing Prognosis in Advanced Dementia
© 2019 Society of Hospital Medicine
- Avoid assumptions about cultural and religious beliefs: Be curious and demonstrate cultural humility to all patients.
“Are there any cultural or spiritual beliefs that are important to you or your mother?”
- Avoid spending too much time on clinical details: Give families time to share stories about the patient in better days as this gives you an opportunity to get to know the patient.
“Tell me more about what your mother was like when she was healthy.”
- Listen first, recommend second: Refrain from making recommendations about the patient’s care before you understand his/her values and preferences.
“What would your mother say is most important to her as her health worsens?”
- Use active listening techniques: Using reflection statements can confirm your understanding of the caregiver’s view point.
“So, I hear that your mother valued being at home and being comfortable. Is that correct?”
These conversations are often an iterative process of helping the patient and family traverse the course of AD. Therefore, starting the process even during a hospitalization earlier in the course of AD can help engage in preparedness planning to provide goal-concordant care and help optimize the patient’s quality of life.
CONCLUSION
Hospitalization among patients with AD can signal a significant change in prognosis and represents an important opportunity for further dialogue. A patient- and caregiver-centered conversation, sharing prognosis and learning about values important to the patient and family, has the potential to lead to less burdensome interventions. Doing so can minimize harm, promote quality of life, and reduce unnecessary care transitions near the end of life.
Disclosures
The authors have nothing to disclose.
Funding
Dr. Havyer was supported, in part, by the Mayo Clinic Department of Medicine Catalyst for Advancing in Academics grant. Dr. Abedini was supported by the National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
