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Physicians can help family members caring for dying loved ones

, the authors have the following recommendations for physicians:

1) Listen carefully to family members and provide proactive guidance, particularly when the patient is no longer able to make decisions about his or her own health care. This includes sharing data on the efficacy of feeding tubes and cardiopulmonary resuscitation in relevant situations and explaining the role of hospice. Ultimately, physicians have a role in helping families come to understand what their loveD one's medical care signifies "including the particular family's definitions of doing everything," "giving up," or "letting go," said Rabow.

2) Facilitate advance care planning. This may include discussion with the family members about preferences, values and goals for end-of-life care. Physicians can also encourage family members to explore legal advance directives, the naming of a health care proxy, the execution of a living will, and plans for autopsy, organ donation, funerals and disposition of possessions. Advance care planning is not a static document or set of instructions, but rather an ongoing process and an opportunity to engage with families and patients, he said.

3) Be part of the interdisciplinary home care team that provides caregivers with orientation, information, training and support. He explained that family caregivers are medical team representatives in the home, providing medical services and assessments, including complex decisions about when to call the physician or bring the patient to the Emergency Room - all with little preparation, training or compensation. Specifically, physicians should give caregivers careful instructions about medication and how to convey their loved one's wishes about advance care directives if it is necessary to call for emergency help, Rabow said. He added that physician home visits have been shown to improve patient quality of life and delay nursing home admissions.

4) Have empathy for family emotions and relationsh
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Contact: Maureen McInaney
mmcinaney@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
27-Jan-2004


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