Physicians who care for patients with life-threatening illnesses face daunting communication challenges. Patients and family members can react to difficult news with sadness, distress, anger, or denial. This book defines the specific communication tasks involved in talking with patients with life-threatening illnesses and their families. Topics include delivering bad news, transition to palliative care, discussing goals of advance-care planning and do-not-resuscitate orders, existential and spiritual issues, family conferences, medical futility, and other conflicts at the end of life. Drs Anthony Back, Robert Arnold, and James Tulsky bring together empirical research as well as their own experience to provide a roadmap through difficult conversations about life-threatening issues. The book offers both a theoretical framework and practical conversational tools that the practising physician and clinician can use to improve communication skills, increase satisfaction, and protect themselves from burnout.

The grandmother granddaughter conversation examined in this book makes explicit what the detailed study of interaction reveals about two social problems--"bulimia" and "grandparent caregiving." For the first time, systematic attention is given to interactional activities through which family members display ordinary yet contradictory concerns about health and illness: * a grandmother's (who is also a registered nurse) attempts to initiate, confront, and remedy her granddaughter's lack of responsibility in admitting bulimic "problems" and committing to professional medical assistance; * a granddaughter's methods for avoiding ownership of the alleged bulimic problems by discounting the legitimacy of her grandmother's expressed concerns. Through analysis of a single audio-recorded and transcribed conversation, Wayne Beach reveals the altogether pervasive and often troubled talk surrounding family medical predicaments. From a careful review of extant theories that seek to explain eating disorders and grandparent caregiving, it becomes clear that an overreliance on self-report data has promoted underspecified understandings of "social contexts" -- conceptualizations void of real time practices and interactional consequences mirroring how families manage their daily affairs and understandings regarding health and illness. In contrast, this volume draws attention to family members' embodied interactional activities. Here it is seen, for example, how methods for expressing concern and caring by individuals may nevertheless eventuate in interactional troubles and problems between family members. The analysis reveals that, while displays of basic concerns for others' health and well being are routine occurrences between family members in home environments -- and of course, across friendship and various support networks -- even the delicate and well-intended management of such occasions guarantees neither agreement on the nature of the alleged "problems" nor, consequently, a commitment to seek professional help as a means of remedying a medical condition. In such cases, the very existence of an illness is itself a matter of some contention to be interactionally worked out. And it is perhaps both predictable and symptomatic that those explicitly denying (or as with the granddaughter, indirectly failing to admit) that problematic health behaviors exist, also somehow let it be made known that far too much attention is being given to possibilities and consequences of illness in the first instance. Implications of this investigation extend well beyond "bulimia" and "grandparent caregiving" to a vast array of casual and institutional involvements between family members, friends, and bureaucratic representatives such as those involved in long-term caregiving, dealing with cancer and Alzheimer's disease, or conducting psychiatric interviews and HIV/AIDS counseling sessions. Findings regarding the interactionally organized nature of talk about bulimia, as well as the problematic nature of caregiving, will be of value to researchers focusing on language and social interaction, health practitioners, and families alike. This volume includes the full transcript of the conversation in the case study. A copy of the audio-recording is available for classroom adoption and/or personal purchase by contacting: Wayne A. Beach, School of Communication, San Diego State University, San Diego, CA 92182-4516.

Anatole Broyard, long-time book critic, book review editor, and essayist for the New York Times, wants to be remembered. He will be, with this collection of irreverent, humorous essays he wrote concerning the ordeals of life and death—many of which were written during the battle with cancer that led to his death in 1990. A New York Times Notable Book of the Year “A heartbreakingly eloquent and unsentimental meditation on mortality . . . Some writing is so rich and well-spoken that commentary is superfluous, even presumptuous. . . . Read this book, and celebrate a cultured spirit made fine, it seems, by the coldest of touches.”—Los Angeles Times “Succeeds brilliantly . . . Anatole Broyard has joined his father but not before leaving behind a legacy rich in wisdom about the written word and the human condition. He has died. But he lives as a writer and we are the wealthier for it.”—The Washington Post Book World “A virtuoso performance . . . The central essays of Intoxicated By My Illness were written during the last fourteen months of Broyard’s life. They are held in a gracious setting of his previous writings on death in life and literature, including a fictionalized account of his own father’s dying of cancer. The title refers to his reaction to the knowledge that he had a life-threatening illness. His literary sensibility was ignited, his mind flooded with image and metaphor, and he decided to employ these intuitive gifts to light his way into the darkness of his disease and its treatment. . . . Many other people have chronicled their last months . . . Few are as vivid as Broyard, who brilliantly surveys a variety of books on illness and death along the way as he draws us into his writer’s imagination, set free now by what he describes as the deadline of life. . . . [A] remarkable book, a lively man of dense intelligence and flashing wit who lets go and yet at the same time comtains himself in the style through which he remains alive.”—The New York Times Book Review “Despite much pain, Anatole Broyard continued to write until the final days of his life. He used his writing to rage, in the words of Dylan Thomas, against the dying of the light. . . . Shocking, no-holds-barred and utterly exquisite.”—The Baltimore Sun

“Engaging . . . provides patients tools they can use to improve dialogue with their doctors and, ultimately, improve their ultimate medical outcomes.”—The Times of Israel The health-care system in the United States is by far the most expensive in the world, yet its outcomes are decidedly mediocre in comparison with those of other countries. Poor communication between doctors and patients, Dennis Rosen argues, is at the heart of this disparity, a pervasive problem that damages the well-being of the patient and the integrity of the health-care system and society. Drawing upon research in biomedicine, sociology, and anthropology and integrating personal stories from his medical practice in three different countries (and as a patient), Rosen shows how important good communication between physicians and patients is to high-quality—and less-expensive—care. Without it, treatment adherence and preventive services decline, and the rates of medical complications, hospital readmissions, and unnecessary testing and procedures rise. Rosen illustrates the consequences of these problems from both the caregiver and patient perspectives and explores the socioeconomic and cultural factors that cause important information to be literally lost in translation. He concludes with a prescriptive chapter aimed at building the cultural competencies and communication skills necessary for higher-quality, less-expensive care, making it more satisfying for all involved. “An excellent source of ideas on how to enhance treatment.”—Joseph Shrand, Instructor of Psychiatry at Harvard Medical School “[Dr. Rosen] delivers much of his advice through anecdotes that take readers on a journey through a career filled with both positive and negative instances of doctor-patient communication.”—Health Affairs

This book will be the first of its kind to offer intensive conversation analysis on patient-clinician interactions in the context of palliative medicine. The book focuses on a series of individual case studies of conversations that revolve, in each case, around one key critical term that is often evoked or understood differently by clinicians and patients.

"There is an unspoken dark side of American medicine--keeping patients alive at all costs. Two thirds of Americans die in healthcare institutions tethered to machines and tubes, even though research indicates that most prefer to die at home in comfort, surrounded by loved ones. The question How do you want to live? must be posed to the seriously ill because they deserve to choose. If doctors explain options--including the choice to forego countless medical interventions that are often of little benefit--then patients can tell doctors how they wish to spend the remainder of their lives. A doctor's heroic efforts to prolong a life can instead prolong that patient's death, and these traumatic measures also bankrupt the healthcare system. One third of the Medicare budget is spent on the last six months of life, often on technological interventions that are not helpful and inflict more suffering. Through the stories of six patients and six very different end-of-life experiences, Volandes explores the trajectory of events and treatments that occur with and without this essential conversation. He argues for a radical re-envisioning of the patient-doctor relationship--including videos to spark discussions--and offers ways for patients and their families to talk about this difficult issue to ensure that patients will be at the center and in charge of their medical care"--Provided by publisher.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.