By Lindsay D. Andronaco RN, BSN, CWCN, WOC, DAPWCA, FAACWS

In the past two blogs I have discussed a controversial topic, skin failure. We all have strong feelings on this topic and have experienced different cases in our practice. Dispute the controversial feelings on KTUs and skin failure; I would like to now just address the viewpoint of the family and how to approach these difficult conversations.

Discussing Palliative Care with Patients and Their Families

Palliative care, in general, must be approached sensitively. However, as providers, we have to address and clearly explain the clinical findings. For example, I had a patient who had stage IV pancreatic cancer and towards the end of his life he shows signs of skin failure. He was in the ICU, on TF, in renal failure, and was on a significant amount of pressers. His family was in shock that this may be the end. They believed he was going to battle the pneumonia and come home. Our job is not to remove their faith and hope that their loved one will get better. Instead, it is up to the heath care team to allow the family time to process this information and develop a plan of care. I find it important to educate, taking the time to thoroughly explain and answer questions that the patient and family members may have. In addition, make sure to evaluate if the patient is competent to make their own end of life decisions. If they are not, ask if they have appointed a surrogate decision maker.

Setting appropriate goals and discussing hospice and/or a palliative care consultation can be difficult to address. The Center to Advance Palliative Care has come up with multiple tools on their website that can be helpful to practitioners as they approach the family and patient with this topic. One of the most useful tools addresses how to begin difficult conversations:

1) Reflect thoughts, emotions, or behavior
a) You seem very...
b) It seems like you are having a hard time deciding between ____ and ____
2) Affirmation and respect
a) I can do a better job as your doctor if I know how you are feeling
3) Summarize/paraphrase
4) Make a plan
5) Deal with anger

As you communicate with your patient and their family, ensure to address advanced care planning, DNR/code status, artificial nutrition, pain control, how the disease impacts their quality of life and what the progression of the disease will consist of. It is also important to understand how they culturally and religiously view death, and to be respectful of that.

Source
http://www.capc.org/ipal-icu/improvement-and-clinical-tools/

About the Author
Lindsay (Prussman) Andronaco is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. Her clinical focus is working with Diabetic Limb Salvage/Surgical/Plastic Reconstruction patients, though her interests and experience are varied and include surgical, urological and burn care, biotherapeutics and Kennedy Terminal Ulcer research. Lindsay is the 2011 recipient of the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse' and has been recognized in Case In Point Magazine as being one of the "Top People in Healthcare" for her "passionate leadership and an overall holistic approach to medicine."

Lindsay is board certified in wound care by the Wound Ostomy Continence Nursing Certification Board. She also is a Diplomate for the American Professional Wound Care Association. In 2011, Lindsay was honored with the Dorland Health People's Award in the category of 'Wound Ostomy Continence nurse.'

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.