Portal de Periódicos da CAPES

On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near Death

2005; American College of Physicians; Volume: 142; Issue: 8 Linguagem: Inglês

10.7326/0003-4819-142-8-200504190-00033

1539-3704

Anthony L. Back, Robert M. Arnold, James A. Tulsky, Walter F. Baile, Kelly Fryer‐Edwards,

Grief, Bereavement, and Mental Health

Medical Writings: Words That Make a Difference19 April 2005On Saying Goodbye: Acknowledging the End of the Patient–Physician Relationship with Patients Who Are Near DeathAnthony L. Back, MD, Robert M. Arnold, MD, James A. Tulsky, MD, Walter F. Baile, MD, and Kelly A. Fryer-Edwards, PhDAnthony L. Back, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., Robert M. Arnold, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., James A. Tulsky, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., Walter F. Baile, MDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195., and Kelly A. Fryer-Edwards, PhDFrom University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-8-200504190-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Ms. White is being discharged with home hospice after an admission for malignant bowel obstruction. Her physician, Dr. B., has come by on rounds and has finished answering her questions. He is finishing up his encounter: "Well, it sounds like everything is ready for you at home, and I'm glad you're feeling better. You'll be in good hands with hospice. I'll see you later."Ms. White, a woman with metastatic colon cancer, has been seeing Dr. B. at least once per month for 2 years, and now she is dying. If asked, Dr. B. would acknowledge that "see you later" ...References1. 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 Scholar2. 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 Scholar3. Bedell SE, Cadenhead K, Graboys TB. The doctor's letter of condolence. N Engl J Med. 2001;344:1162-4. [PMID: 11302139] CrossrefMedlineGoogle Scholar4. Irvine P. The attending at the funeral. N Engl J Med. 1985;312:1704-5. [PMID: 4000217] CrossrefMedlineGoogle Scholar5. Mount BM. Dealing with our losses. J Clin Oncol. 1986;4:1127-34. [PMID: 3723168] CrossrefMedlineGoogle Scholar6. Osler W. Aequanimitas. New York: McGraw-Hill; 1932. Google Scholar7. Shapiro A. The Vigil. Chicago: Univ of Chicago Pr; 1997. Google Scholar8. Lipsyte R. In the Country of Illness: Comfort and Advice for the Journey. New York: Alfred Knopf; 1998. Google Scholar9. Singer PA, Martin DK, Kelner M. Quality end-of-life care: patients' perspectives. JAMA. 1999;281:163-8. [PMID: 9917120] CrossrefMedlineGoogle Scholar10. Redinbaugh EM, Sullivan AM, Block SD, Gadmer NM, Lakoma M, Mitchell AM, et al. Doctors' emotional reactions to recent death of a patient: cross sectional study of hospital doctors. BMJ. 2003;327:185. [PMID: 12881257] CrossrefMedlineGoogle Scholar11. Graham J, Potts HW, Ramirez AJ. Stress and burnout in doctors [Letter]. Lancet. 2002;360:1975-6; author reply 1976. [PMID: 12493290] Google Scholar12. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM, Leaning MS, et al. Burnout and psychiatric disorder among cancer clinicians. Br J Cancer. 1995;71:1263-9. [PMID: 7540037] CrossrefMedlineGoogle Scholar13. Zisook S, Shuchter S, Schuckit M. Factors in the persistence of unresolved grief among psychiatric outpatients. Psychosomatics. 1985;26:497-9, 503. [PMID: 4011815] CrossrefMedlineGoogle Scholar14. Martin JL. Psychological consequences of AIDS-related bereavement among gay men. J Consult Clin Psychol. 1988;56:856-62. [PMID: 3204195] CrossrefMedlineGoogle Scholar15. Barry LC, Kasl SV, Prigerson HG. Psychiatric disorders among bereaved persons: the role of perceived circumstances of death and preparedness for death. Am J Geriatr Psychiatry. 2002;10:447-57. [PMID: 12095904] CrossrefMedlineGoogle Scholar16. Jackson VA, Mack J, Matsuyama R, Lakoma MD, Sullivan AM, Arnold RM, et al. "The Cat's on the Roof..." and other approaches to discussion at the end of life: a study of oncologists. J Palliat Med [In press]. Google Scholar17. Brent SB, Speece MW, Gates MF, Mood D, Kaul M. The contribution of death-related experiences to health care providers' attitudes towards dying patients: 1. Graduate and undergraduate nursing students. Omega: the Journal of Death and Dying. 1991;23:249-78. CrossrefGoogle Scholar18. Bayer R, Oppenheimer GM. AIDS Doctors: Voices from the Epidemic. New York: Oxford Univ Pr; 2000. Google Scholar19. Remen RN. Recapturing the soul of medicine: physicians need to reclaim meaning in their working lives. West J Med. 2001;174:4-5. [PMID: 11154646] CrossrefMedlineGoogle Scholar20. Bonanno GA. Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? Am Psychol. 2004;59:20-8. [PMID: 14736317] CrossrefMedlineGoogle Scholar21. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995;122:368-74. [PMID: 7847649] LinkGoogle Scholar22. Novack DH, Suchman AL, Clark W, Epstein RM, Najberg E, Kaplan C. Calibrating the physician. Personal awareness and effective patient care. Working Group on Promoting Physician Personal Awareness, American Academy on Physician and Patient. JAMA. 1997;278:502-9. [PMID: 9256226] CrossrefMedlineGoogle Scholar23. Epstein RM. Mindful practice. JAMA. 1999;282:833-9. [PMID: 10478689] CrossrefMedlineGoogle Scholar24. Meier DE, Back AL, Morrison RS. The inner life of physicians and care of the seriously ill. JAMA. 2001;286:3007-14. [PMID: 11743845] CrossrefMedlineGoogle Scholar25. Wilber K. Grace and Grit: Spirituality and Healing in the Life and Death of Treya Killam Wilber. Boston: Shambhala; 2001. Google Scholar26. Back AL, Arnold RM, Tulsky JA, Baile WF, Fryer-Edwards KA. Teaching communication skills to medical oncology fellows. J Clin Oncol. 2003;21:2433-6. [PMID: 12805343] CrossrefMedlineGoogle Scholar27. Baile WF, Glober GA, Lenzi R, Beale EA, Kudelka AP. Discussing disease progression and end-of-life decisions. Oncology (Huntingt). 1999;13:1021-31; discussion 1031-6, 1038. [PMID: 10442349] Google Scholar28. Back AL, Arnold RM, Quill TE. Hope for the best, and prepare for the worst. Ann Intern Med. 2003;138:439-43. [PMID: 12614110] LinkGoogle Scholar29. Block SD. Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians–American Society of Internal Medicine. Ann Intern Med. 2000;132:209–18. [PMID: 10651602] MedlineGoogle Scholar30. Block SD. Perspectives on care at the close of life. Psychological considerations, growth, and transcendence at the end of life: the art of the possible. JAMA. 2001;285:2898-905. [PMID: 11401612] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1023; University of Pittsburgh, Pittsburgh, PA 15213-2582; Durham Veterans Affairs Medical Center and Duke University, Durham, NC 27705; University of Texas M.D. Anderson Cancer Center, Houston, TX 77230-1402; and University of Washington, Seattle, WA 98195.Acknowledgments: The authors acknowledge all of the fellows who have participated in Oncotalk retreats over the past 3 years, the amazing actors who have shown us the power of goodbyes, and Holly Prigerson, PhD, for helpful conversations about empirical studies examining grief.Grant Support: By the National Cancer Institute (NCI R25 92055).Disclosures: None disclosed.Corresponding Author: Anthony L. Back, MD, Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle WA 98109-1023; e-mail, [email protected]washington.edu.Current Author Addresses: Dr. Back: Seattle Cancer Care Alliance, 825 Eastlake Avenue East, Box 19023, Seattle, WA 98109-1023.Dr. Arnold: University of Pittsburgh Medical Center Montefiore Hospital, 200 Lothrop Street, W933, Pittsburgh, PA 15213-2582.Dr. Tulsky: Durham Veterans Affairs Medical Center and Duke University, 508 Fulton Street, Durham, NC 27705.Dr. Baile: University of Texas M.D. Anderson Cancer Center, Unit 431, Box 301402, Houston, TX 77230-1402.Ms. Fryer-Edwards: University of Washington, 1959 Pacific Avenue, Seattle, WA 98195. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBeyond Patient-Provider Relationships: Expanding the Roles and Boundaries of Families during Patient End-of-Life"Remembrance": A Self-Care Tool for CliniciansBereavement After a Child's DeathNarrative intervention: Stories from the front lines of oncology health careFamilies' Sense of Abandonment When Patients Are Referred to HospiceEnd of Life SupportWhat can we learn from simulation-based training to improve skills for end-of-life care? Insights from a national project in IsraelThe Troubles of TellingThe final goodbye'I deal with the small things': The doctor–patient relationship and professional identity in GPs' stories of cancer careBuoyancy: A Model for Self-Reflection about Stress and Burnout in Oncology Providers"When patients and families feel abandoned"The End-of-Life Family Meeting in Intensive Care Part I: Indications, Outcomes, and Family NeedsDo Oncologists Engage in Bereavement Practices? A Survey of the Israeli Society of Clinical Oncology and Radiation Therapy (ISCORT)Bereavement: Addressing Challenges Faced by Advanced Cancer Patients, Their Caregivers, and Their PhysiciansContacting Bereaved Relatives: The Views and Practices of Palliative Care and Oncology Health Care ProfessionalsCommunication about cancer near the end of lifeJust Say CancerDNAR Does Not Equate to "Do Not Care"Communication Skills: A Call for Teaching to the TestClosure for patients at the end of a cancer clinical trial: literature reviewPALLIATIVE CARE IN SPECIFIC NEUROLOGICAL DISEASESAfrontamiento emocional de la muerte. Información y comunicación 19 April 2005Volume 142, Issue 8Page: 682-685KeywordsBreast cancerCaregiversEmotionsForecastingGratitudeMotivationNauseaNursesRunningTouch ePublished: 19 April 2005 Issue Published: 19 April 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...