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Strategies for approaching common issues in palliative and end-of-life care that may be culturally influenced: Assessing preferences for information-sharing and medical decision-making

Strategies for approaching common issues in palliative and end-of-life care that may be culturally influenced: Assessing preferences for information-sharing and medical decision-making
Strategies Suggested phrases and tools
  • Ask patients how they prefer to receive information and make decisions.
  • "I want to provide you with the best possible care. It would help me to understand more about how you like to receive information about your health and how you and your family make decisions. Is it okay if I ask you some questions about that?"[1,2]
  • If given permission to proceed:
    • "How much information about what is likely to be ahead with your illness would you like from me?"[3]
    • "How have you made important decisions in the past?"
  • Ask patients whom they wish to have present when receiving information and making decisions.
  • "Is there anyone you would like here while we talk?"
  • "How much does your family know about your priorities and wishes?"[3]
  • If the family requests that the patient not be informed, ask the patient an open-ended question about their information-sharing preferences, preferably with key family members present in order to maintain trust.
    • Prepare the family in advance that the patient's wishes will be honored, whichever way they are expressed.
  • "I have information about your illness. Would you like me to talk with you or is there someone else you prefer me to speak with?"
  • Consider checking in intermittently regarding the patient's desired level of involvement.
  • "Your family and I are planning to discuss how best to take care of you. Would you like to participate in that conversation, or should we proceed without you?"
References:
  1. Smith AK, Sudore RL, Perez-Stable EJ. Palliative care for Latino patients and their families: whenever we prayed, she wept. JAMA 2009; 301:1047.
  2. Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978; 88:251.
  3. Bernacki RE, Block SD. Communication about serious illness care goals: A review and synthesis of best practices. JAMA Intern Med 2014; 174:1994.
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