How Do We Improve Communication About Palliative Care?

An interview with palliative care physician Dr. Steven Pantilat, Part One

Today, SevenPonds speaks with Dr. Steven Pantilat, a San Francisco-based healthcare professional with an expertise in palliative care. Dr. Pantilat teaches at UCSF, and consults with hospitals and other healthcare facilities on the best methods for improving communication about palliative care. His goal is to help doctors communicate more effectively with patients, allowing patients to make more informed decisions about their palliative care services. In addition to his work in the healthcare field, Dr. Pantilat has also published books about palliative care. He released a new book, “Life After the Diagnosis,” earlier this year. 

A portrait of Dr. Steven PantilatMarissa Abruzzini: What made you want to study palliative care? 

Dr. Steven Pantilat: I love people, and I love caring for people. Palliative care allows me to really help people with serious illness — there is always something we can do to help people feel better. Palliative care also focuses on caring for the whole person and allows me to really get to know my patients and their loved ones. It’s not that you can’t do that in any other field of medicine, but it’s a real focus in palliative care. I also love that we practice palliative care as a team. I have wonderful nurse, social worker, chaplain and doctor colleagues, and we practice together. It’s a wonderful way to practice.

Marissa: What are some of the common challenges that doctors face when they communicate with patients about palliative care? 

Dr. Pantilat: It’s hard to give bad news to patients. It feels bad and makes everyone sad, including patients, families and doctors. And yet, it is essential that patients and doctors talk about difficult things (including the end of life) honestly and openly so that patients can make decisions consistent with their values, preferences and goals, and receive the care they want.

Marissa: What are some of the solutions that you’ve found for this problem? 

Dr. Pantilat: In sharing bad news, it is best to say the news straight and directly without jargon or euphemisms. I say something like, “Mr. Smith, I’m really sorry to have to tell you this, but the scan showed that the cancer has grown.” Then I pause. I let the news sink in and let Mr. Smith process it. Too often doctors keep talking to fill in the uncomfortable silence, but patients are often stunned and reeling and can’t hear anything. It’s best to give them time. They may even need to schedule a separate appointment in the future to ask all the questions that will inevitably come up after they leave the office.

Marissa: Let’s talk about that. When you first tell a patient that he has a terminal illness, what are some of the first steps he should take to get the care he needs? A palliative care nurse holds a patient's hand

Dr. Pantilat: An important first step after a serious diagnosis is to find the doctor that will care for you through the illness. If you already have a doctor you like and trust, you are ahead of the game. If you don’t, you’ll need to find one with expertise and who has experience with your illness.

Marissa: How does a patient decide whether a certain treatment plan will actually help them or make things worse? 

Dr. Pantilat: You should ask your doctor questions. It’s the best way to find out. And make sure you get straightforward answers. Ask about side effects and complications. Ask if you are the type of person in whom the treatment has been studied, and how similar you are to people in the studies. The more similar you are, the more likely that your chances of success will match those in the study.

Make sure you understand the jargon. When a doctor says there is a 30 percent chance of responding to chemotherapy, that means that there is a 30 percent chance that the cancer will slow down or shrink with chemo. But many people think that “response” means that they have a 30 percent chance of being cured of the cancer. You need to undertake treatments knowing the reality, not the fantasy, of what the treatments can do.

Also, you can talk to people who have undergone the treatment. But, in this case, you are more likely to talk with people who have done well with that particular treatment.

Marissa: What can doctors do to make patients feel more comfortable talking about palliative care, and feel less stressed over the process? 

Dr. Pantilat: Palliative care itself is not stressful — it helps people feel better. The key is to understand that palliative care is not about the end of life, it’s about living as well as possible for as long as possible. The stressful part is if you think that palliative care means you are dying. It doesn’t mean that. It does mean that you have a serious illness and that it’s important to think carefully about your quality of life, how you choose treatments and what is most important to you.

Join us next week for part two of our interview with Dr. Steven Pantilat, where he talks about some of the ways that his patients have successfully coped with terminal illness and other serious medical conditions. 

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