1.Kyle P. Edmonds, MD Institute for Palliative Medicine San Diego Hospice

2. ActionsExperiencesOutcomeConfidence Interval 3. Kelley et al., 2010. 4. Weeks et al., 1998. 5. Gomes & Higginson, 2006. 6. CRISISDx Focus on Curative Therapy RemissionPeace of MindReoccurrence CRISISFurther Curative Therapy CRISISNo Further Curative Options 7. High Level of Requested Prognostic Info United States93%United Kingdom85%Japan80%Greece50%Italy32%Spain12% Parker et al., 2007. 8. PatientProviderFamily 9. Differs patient-to-patient Provider assumptionsJohnson et al., 2011. 10. Heyland et al, 2006 11. Johnson et al., 2011. 12. SparseConflictedContradictoryAvoidantToo rushedHopelessBrink of Death Waldrop et al., 2012. 13. Poor treatment adherence Unplanned admissions Low pt/provider congruity Less decision-making involvement DepressionHarding et al., 2008. 14. Zier et al., 2009. 15. Parker et al., 2007. 16. Would you want CPR? As you are now?In a less healthy state?Kass-Bartelmes et al, 2003 17. Permanent coma worse than death:Kass-Bartelmes et al., 2010. 18. Dementia worse than death:Kass-Bartelmes et al., 2010. 19. Weeks et al., 2012. 20. Zier et al., 2012. 21. Express optimism Patient possesses special fortitude Disbelief in physicians ability to prognosticate Prognosis as a gist[] And we are talking I dont give a lot of weight to about my father in this Ultimately, I dont think the guess I understand that I individual number, I tend case, not just any patient. I [doctors] can really know not to trust the eventually [the patient] mayindividual know that my chancecould the percent father of number as I just as the dieI guess muchhave to do better than someone survival unless what the overall feeling that [the hope more. doctorcomes in dead.I think is sayingand physician] is conveying. he will.Adapted from: Zier et al., 2012. 22. Data Chosen Role Trust in ProviderCuesPatientFramingAmbivalenceCoping StyleBeliefsHistory 23. Experiences AssumptionsEducationPopulation DataProviderProfessional Norms Chosen RolePatient DataAmbivalence Beliefs 24. Attributes on which patients and physicians differ: 1. 2. 3. 4. 5. 6.Be mentally aware Be at peace with God Not a burden to family Be able to help others Pray Have funeral arrangements planned 7. Not be a burden to society 8. Feel ones life is complete Steinhauser et al., 2000. 25. ActionsExperiencesDefining HopeAmbivalenceFramingAssumptionsTailoringOutcomeAffective CuesAvoidance Lack of TrustConfidence Interval 26. Kyle P. Edmonds, MD kyle.p.edmonds@gmail.com kylepedmonds.com 27. Barnes S et al. (2012). Enhancing patient-professional communication about end-of-life issues in life-limiting conditions: A critical review of the literature. J Pain Sympt Mgmt. 44(6): 866-879. Botti S & SS Iyengar (2004). The psychological pleasure and pain of choosing: when people prefer choosing at the cost of subsequent satisfaction. J Personal Soc Psychol 87(3):31226. 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