Openly acknowledge that you cannot cure the patient’s disease, but that you (and the patient and family) can do a lot to manage this final stage of the illness.
- Set clear and practical goals to control symptoms and support activities of daily living. People like to have a plan.
- Death is a taboo subject. There may be pressure on both doctor and patient not to mention the ‘D’ word. No patient should be denied the knowledge that he or she is dying. Any desire from the family to keep the patient in the dark should be sensitively overruled. A family conference may do much to explore and deal with family fears.
- Do not assume that the patient knows that he or she is dying and that the specialists will have dealt with the ‘prognosis issue’. Some specialists are still less than frank about death. Even when patients have been told that they will die, they will often not remember being told. The prognosis issue goes on being an issue after the patient is made aware of it.
- Dealing with dying patients will often bring up our own fears about mortality.