The initial interview in palliative care consultation
- Timothy E Quill, MD
Timothy E Quill, MD
- Professor of Medicine, Psychiatry and Medical Humanities
- University of Rochester School of Medicine
The clinical interview in palliative care is not only central to the information gathering process – to understanding and being able to address patient and family suffering – but is also a fundamental therapeutic method. Good communication skills, while always important in clinical medicine, are especially indispensable in the context of a life-threatening illness where fear, anxiety, existential terror, and terrible sadness can make for a challenging clinician-patient relationship. A key task for the palliative care consultant is to establish a personal connection with the patient that can not only tolerate but also integrate the affect that is typically associated with profound worries about the future and with repeatedly receiving bad news. The palliative care interview aims to collect both routine medical data and, as described below, additional personal information not regularly included in a medical history. (See "Overview of comprehensive patient assessment in palliative care".)
This topic will focus on the initial interview that is conducted during a palliative care consultation for an adult, which includes identifying specialized aspects of information gathering and of developing an intimate, trusting clinician-patient relationship that can address a broad range of biopsychosocial and existential/spiritual issues. An overview of the domains of the comprehensive palliative care assessment, and a number of related topics in medical consultation and palliative care are covered elsewhere. (See "Overview of comprehensive patient assessment in palliative care" and "Overview of the principles of medical consultation and perioperative medicine" and "Benefits, services, and models of subspecialty palliative care" and "Communication of prognosis in palliative care" and "Survival estimates in advanced terminal cancer" and "Communication in the ICU: Holding a family meeting" and "Discussing serious news" and "Overview of spirituality in palliative care" and "Approach to symptom assessment in palliative care" and "Pediatric palliative care" and "Ethical issues in palliative care" and "Assessment of decision-making capacity in adults".)
GOALS OF BOTH PATIENTS AND CLINICIANS
When patients and families facing a serious and/or life-threatening illness are asked what matters most to them, comfort is a foremost concern. However, issues that extend beyond the usual biomedical goals of clinical care are also cited [1-4]:
●Avoiding inappropriate prolongation of dying
●Relieving the burden on the family
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- GOALS OF BOTH PATIENTS AND CLINICIANS
- PROBLEMS IN COMMUNICATING WITH PATIENTS WHO HAVE SERIOUS ILLNESS
- PREPARING FOR THE CONSULTATION
- Getting started
- - Greeting
- - Patient-centered interview: Process
- - Patient-centered interview: Content
- Patient-centered interview: Responding to emotions
- CLINICIAN-CENTERED INTERVIEW
- Patient and family education
- Care planning: Establishing goals of care and making a recommendation
- Arranging follow-up
- COMMUNICATING WITH THE CARE TEAM
- CLINICIAN SELF CARE