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.

The story of the end-of-life experience of a palliative care physician who helped thousands of patients to die well. We all die. Most of us spend the majority of our lives ignoring this uncomfortable truth, but Dr. Larry Librach dedicated his life and his career to helping his patients navigate their final journey. Then, in April 2013, Larry was diagnosed with terminal pancreatic cancer. Unlike the majority of us, Larry knew the death he wanted. He wanted to die at home, surrounded by his family: his wife of forty years, his children, and his grandchildren. He did. He was peaceful and calm at the end. Larry proved that the “good death” isn’t a myth. It can be done, and he showed us how. Ever the teacher, Larry made his last journey a teachable moment on how to die the best death possible, even with a pernicious disease. As hard as it is to guide patients toward dying well, it is far harder to live those precepts day by day as the clock ticks down to one’s own death, but Larry, together with author Phil Dwyer, chronicled his final journey with courage and humour.

Dying - which we all inevitably must do - can be appreciably better for each of us if we approach end of life conversations early, while we still have the capacity to make our own decisions. This book can help us all with this. In addition, Courageous Conversations on Dying guides physicians in their role of supporting patients and families through decision-making for end of life, concentrating on patients' goals. Whether we are physicians, patients, family members, or caring individuals who want the best possible end of life experience for ourselves and each other, we must acquire the skills for loving, fruitful conversations. In this book, you'll learn how to prepare for these conversations, including what kind of setting, what words to use, how to be a good listener, how to empathize, how to help in decision-making, how to properly document end of life wishes, and more, along with many case studies to illustrate the points.

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.

"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.