Acp books patients want better end of life care and physicians want to provide it but in a society where high tech interventions are often emphasized moving from curative treatment to comfort care is sometimes difficult often patients in the last phase of life want both continued aggressive treatments and the benefits of palliative measures. A pragmatic 4 step approach to discussing end of life care is outlined in table 1 the physician sensitively initiates the discussion so as to create a forum for ongoing dialogue subsequent discussion serves to clarify prognosis identify end of life goals and finally to develop a treatment plan. Patients want better end of life care and physicians want to provide it but in a society where high tech interventions are often emphasized moving from curative treatment to comfort care is sometimes difficult. A physicians guide to talking about end of life care step 1 initiating discussion o establish a supportive relationship with patient and family o appoint a surrogate decision maker o elicit general thoughts about end of life preferences go beyond stock phrases with probing questions step 2 clarifying prognosis o be direct yet . 2 end of life resource guide preface intro background purpose physician referral referral for health care services and contacts for bereavement counseling o local health departments available for end of life care planning range from volunteer and bereavement programs one
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