Portal de Periódicos da CAPES

“I Wish Things Were Different”: Expressing Wishes in Response to Loss, Futility, and Unrealistic Hopes

2001; American College of Physicians; Volume: 135; Issue: 7 Linguagem: Inglês

10.7326/0003-4819-135-7-200110020-00022

1539-3704

Timothy E. Quill, Robert M. Arnold, Frederic W. Platt,

Ethics and Legal Issues in Pediatric Healthcare

Medical Writings2 October 2001"I Wish Things Were Different": Expressing Wishes in Response to Loss, Futility, and Unrealistic HopesTimothy E. Quill, MD, Robert M. Arnold, MD, and Frederic Platt, MDTimothy E. Quill, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205, Robert M. Arnold, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205, and Frederic Platt, MDDr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-135-7-200110020-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicians who care for patients encounter many powerful and painful emotions, including anger, sadness, fear, grief, loss, hopelessness, and blame. Many studies suggest that physicians should express empathy in response to emotion-laden patient statements to ensure that patients feel listened to and understood. These physician responses usually consist of efforts to comprehend how things feel to the patient and to express that understanding back to the patient (1–8).Situations that evoke loss, guilt, or hopelessness are particularly hard for physicians to respond to empathically. Physicians who think that they have failed a dying patient and who fear depriving the patient ...References1. Branch WT, Malik TK. Using 'windows of opportunities' in brief interviews to understand patients' concerns. JAMA. 1993;269:1667-8. [PMID: 8455300] CrossrefMedlineGoogle Scholar2. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP. Improving physicians' interviewing skills and reducing patients' emotional distress. A randomized clinical trial. Arch Intern Med. 1995;155:1877-84. [PMID: 7677554] CrossrefMedlineGoogle Scholar3. Platt FW, Keller VF. Empathic communication: a teachable and learnable skill. J Gen Intern Med. 1994;9:222-6. [PMID: 8014729] CrossrefMedlineGoogle Scholar4. Suchman AL, Markakis K, Beckman HB, Frankel R. A model of empathic communication in the medical interview. JAMA. 1997;277:678-82. [PMID: 9039890] CrossrefMedlineGoogle Scholar5. Barrett-Lennard GT. The phases and focus of empathy. Br J Med Psychol. 1993;66 Pt 1 3-14. [PMID: 8485075] CrossrefMedlineGoogle Scholar6. Platt FW, Platt CM. Empathy: a miracle or nothing at all? Journal of Clinical Outcomes Management. 1998;5:30-3. Google Scholar7. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA. 2000;284:1021-7. [PMID: 10944650] CrossrefMedlineGoogle Scholar8. Coulehan JL, Platt FW, Egener B, Frankel R, Lin CT, Lown B, et al . "Let me see if I have this right": words that build empathy. Ann Intern Med. 2001;135:221-7. LinkGoogle Scholar9. Matthews DA, Suchman AL, Branch WT. Making "connexions": enhancing the therapeutic potential of patient-clinician relationships. Ann Intern Med. 1993;118:973-7. [PMID: 8489112] LinkGoogle Scholar10. Nightingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and physician resource utilization. J Gen Intern Med. 1991;6:420-3. [PMID: 1744756] CrossrefMedlineGoogle Scholar11. . Concise Oxford English Dictionary. 7th ed. Oxford: Oxford Univ Pr; 1993. Google Scholar12. Rie MA. The limits of a wish. Hastings Cent Rep. 1991;21:24-7. [PMID: 1938347] CrossrefMedlineGoogle Scholar13. Ackerman F. The significance of a wish. Hastings Cent Rep. 1991;21:27-9. [PMID: 1938348] CrossrefMedlineGoogle Scholar14. Delvecchio Good MJ, Good BJ, Schaffer C, Lind SE. American oncology and the discourse on hope. Cult Med Psychiatry. 1990;14:59-79. [PMID: 2340733] CrossrefMedlineGoogle Scholar15. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995;122:368-74. [PMID: 7847649] LinkGoogle Scholar16. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. ACP–ASIM End-of-Life Care Consensus Panel. American College of Physicians–American Society of Internal Medicine. Ann Intern Med. 1999;130:744-9. [PMID: 10357694] LinkGoogle Scholar17. Quill TE. Perspectives on care at the close of life. Initiating end-of-life discussions with seriously ill patients: addressing the "elephant in the room.". JAMA. 2000;284:2502-7. [PMID: 11074781] CrossrefMedlineGoogle Scholar18. Byock I. Dying Well: The Prospect for Growth at the End of Life. New York: Riverhead Books; 1997. Google Scholar19. Quill , Timothy E. A Midwife through the Dying Process: Stories of Healing and Hard Choices at the End of Life. Baltimore: Johns Hopkins Univ Pr; 1996. Google Scholar20. Fox RC. Experiment Perilous. Physicians and Patients Facing the Unknown. Glencoe, IL: Free Pr; 1959. Google Scholar21. Lazare A, Eisenthal S, Frank A. Clinician/Patient Relations II: Conflict and Negotiation.. In: Lazare A, eds. Outpatient Psychiatry: Diagnosis and Treatment. 2nd ed. Baltimore: Williams & Wilkins; 1989:157-71. Google Scholar22. . Kohn LT, Corrigan J, Donaldson MS, eds. To Err Is Human: Building a Safer Health System.. In: Kohn LT, Corrigan J, Donaldson MS, eds. Committee on Quality Health Care in America, Institute of Medicine. Washington, DC: National Academy Pr; 2000. Google Scholar Author, Article, and Disclosure InformationAuthors: Timothy E. Quill, MD; Robert M. Arnold, MD; Frederic Platt, MDAffiliations: Dr. Quill: University of Rochester School of Medicine and Dentistry; Rochester, NY 14642Dr. Arnold: University of Pittsburgh School of Medicine; Pittsburgh, PA 15213-2582Dr. Platt: University of Colorado School of Medicine; Denver, CO 80205Acknowledgments: The authors thank the American Academy on Physician and Patient and the Bayer Institute for Health Care Communication. Both organizations have helped the authors to develop their skills in counseling patients and in teaching the physicians these skills.Corresponding Author: Timothy E. Quill, MD, University of Rochester Medical Center, 601 Elmwood Avenue, Box 601, Rochester, NY 14642.Current Author Addresses: Dr. Quill: University of Rochester Medical Center, 601 Elmwood Avenue, Box 601 Rochester, NY 14642Dr. Arnold: Montefiore University Hospital, 200 Lothrop Street, Suite W932, Pittsburgh, PA 15213-2582.Dr. Platt: 1901 East 20th Avenue, Denver, CO 80205. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited by"Am I Going to Die?": Delivering Serious News to Patients With Liver DiseaseBreaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patientsGeriatrics/Frailty and End of Life CareCommunicating About Time-Limited TrialsNeuropalliative Care in the Inpatient SettingDevelopment of the Oncolo-GIST ("Giving Information Strategically & Transparently") Intervention Manual for Oncologist Skills Training in Advanced Cancer Prognostic Information CommunicationImpact of a Novel Goals-of-Care Communication Skills Coaching Intervention for Practicing OncologistsA multipronged approach to teaching end‐of‐life care to student pharmacistsWhen Pediatric Hospitalists Took Care of Adults During the COVID-19 PandemicThe considerations, experiences and support needs of family members making treatment decisions for patients admitted with major stroke: a qualitative studyGoals of Care Conversations in Serious IllnessEthics and Professionalism in Pediatric AnesthesiaPatient-Clinician Communication Issues in Palliative Care for Patients With Advanced CancerEducation in Perinatal Palliative Care for Nurses, Physicians, and Other Health ProfessionalsNavigating the Murky Waters of Hope, Fear, and Spiritual SufferingCommunication Skills Training for General Surgery ResidentsEmotions in the room: common emotional reactions to discussions of poor prognosis and tools to address themWillingness to bear adversity and beliefs about the curability of advanced cancer in older adultsSetting Expectations, Following Orders, Safety, and Standardization: Clinicians' Strategies to Guide Difficult Conversations About Opioid PrescribingKommunikation in der PalliativmedizinEthical Issues in Pediatric AnesthesiologyPrinciples of Narrative Critical CareNephroTalk: Evaluation of a Palliative Care Communication Curriculum for Nephrology FellowsKeeping Expectations in Check With Immune Checkpoint Inhibitors"I'd Recommend …" How to Incorporate Your Recommendation Into Shared Decision Making for Patients With Serious IllnessPalliative Management of Pancreatic CancerEnd of Life SupportUsing a computer simulation for teaching communication skills: A blinded multisite mixed methods randomized controlled trialPalliative Management of Pancreatic CancerA Nephrology Fellows' Communication Skills Course: An Educational Quality Improvement ReportRelationships between personal attitudes about death and communication with terminally ill patients: How oncology clinicians grapple with mortalityAnticipatory GriefNeurologists as primary palliative care providersGiving End-of-Life Spiritual CareRisks, Benefits, and Patients' Treatment Decisions at the End of LifeStatin use in cancer patients with brain metastases: a missed communication opportunity at the end of lifeEffective Communication with Seriously Ill Patients in the HospitalAn Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care UnitsBreaking Bad News and Discussing Goals of Care in the Intensive Care UnitEnd of Life Care in the Intensive Care UnitCommunication Skills Curriculum for Foreign Medical Graduates in an Internal Medicine Residency ProgramCourage, brains and heart: Lessons from the Wizard of Oz for difficult healthcare conversationsPalliative and End-of-Life Care in StrokeHelping Patients with Serious Illness Live Well through the Promotion of Adaptive Coping: A Report from the Improving Outpatient Palliative Care (IPAL-OP) InitiativeKommunikation in der Palliativmedizin"In the Beginning . . . "Discussing CPR When it is a Non-Beneficial InterventionCompassionate care: Enhancing physician–patient communication and education in dermatologyApplying Sociodramatic Methods in Teaching Transition to Palliative CareEvolution of Truth-Telling Practices in Brazil and South AmericaWhat Are the Key Elements to Having a Conversation About Setting Goals and Communicating Serious News?Hope Is an EvilEnhancing Communication Between Oncologists and Patients With a Computer-Based Training Program A Randomized TrialJames A. Tulsky, MD, Robert M. Arnold, MD, Stewart C. Alexander, PhD, Maren K. Olsen, PhD, Amy S. Jeffreys, MStat, Keri L. Rodriguez, PhD, Celette Sugg Skinner, PhD, David Farrell, MPH, Amy P. Abernethy, MD, and Kathryn I. Pollak, PhD"When patients and families feel abandoned"Vital Communication Skills at the End of LifePalliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious IllnessPart II: Family-Centered Decision MakingApproaching Patients and Family Members Who Hope for a MiracleCommunicating about death and dyingCommunication about palliative care and end-of-life planningApproaches to the Difficult Patient/Parent EncounterBreaking Bad News: SchizophreniaBeyond Bad NewsHelping Surrogates Make Decisions #226The Family Meeting: Starting the Conversation #223Palliative Management of Pancreatic CancerEnd of LifeThe Breadth of HopesEnd of Life Decision-Making for Cancer PatientsDepression/anxietyCore Competencies in Palliative Care for Surgeons: Interpersonal and Communication SkillsCommunication about cancer near the end of lifeEducational PerspectivesTeaching and Learning Communication Skills in Medical EducationCommunication Skills: A Call for Teaching to the TestCollaborative Communication in Pediatric Palliative Care: A Foundation for Problem-Solving and Decision-MakingWithdrawal of Mechanical Ventilation in Pediatric and Neonatal Intensive Care UnitsDisclosing Unanticipated Outcomes to PatientsDiagnosing and Discussing Imminent Death in the Hospital: A Secondary Analysis of Physician InterviewsTruth Telling: Yes, but How?For Whom The Bell Tolls . . . "I'm Not Ready for Hospice": Strategies for Timely and Effective Hospice DiscussionsDavid J. Casarett, MD, MA and Timothy E. Quill, MDA Controlled Trial of a Short Course to Improve Residents?? Communication With Patients at the End of LifeDiscussing resuscitation preferences with patients: Challenges and rewardsSurgeons' Attitudes About Communicating With Patients and Their Families"Nobody Understands": On a Cardinal Phenomenon of Palliative CarePalliative care in hospitalsPreventing communication errors in telephone medicineSuicidio médicamente asistido en el final de la vidaTo Feed or Not to Feed: Is That the Right Question?Discussing health care costs with patientsOpportunities and Challenges to Improving End-of-Life Care for Seriously Ill Elderly Patients: A Qualitative Study of Generalist PhysiciansTalking About the Unthinkable: Perinatal/Neonatal Communication Issues and ProceduresDisclosing Adverse Events to PatientsIgnorance Is Bliss? Ethical Considerations in Therapeutic NondisclosureEnd-of-Life Care: Issues Relevant to the Geriatric PsychiatristIn Reply:Responding to Requests Regarding Prayer and Religious Ceremonies by Patients Near the End of Life and Their FamiliesCare not cure: dialogues at the transitionPrinciples of palliative chemotherapyWhen Careproviders Should Give Advice, Disclose Personal Information, and Reveal Their FeelingsSome Words That MatterAggressive Treatment in the Terminally Ill: Right or Wrong?Breaking bad news to patientsDoctor-Patient Communication IssuesLooking Death in the Eye: Facilitating End-of-Life Care and the Grieving Process 2 October 2001Volume 135, Issue 7Page: 551-555KeywordsCommunication in health careEmotionsFearForecastingMortalityMyocardial infarctionPatientsScientistsSuicideThorax ePublished: 2 October 2001 Issue Published: 2 October 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...