When you arrive at a palliative care call you may find differing opinions and expectations about care decisions expressed between:
- The patient and family member(s).
- Family member and family member.
- You and the patient.
- You and the family.
- The substitute decision-maker and you (or family).
Why disagreements may occur
- Misunderstandings, miscommunications, and above all, fear have created confusion and adversarial positions.
- Families have received mixed messages or incomplete information from healthcare providers about the patient’s status.
- There is no advance directive or advance care plan in place, or the care plan has not been updated to reflect the evolving situation.
- Family members who haven’t been part of caring for the patient have recently arrived and aren’t up to speed with what’s happening or in agreement with previously established plans.
- The substitute decision-maker or family wants to change the plan. (Disagreements may occur between family members, especially if there is pre-existing history of conflict. This may be exacerbated if one family member holds the role of substitute decision-maker or other status in the family.)
- The patient’s decline has occurred more rapidly than expected.
- The patient or family is having difficulty understanding or accepting the change in status from acute to palliative care.
I know this is a difficult time. You and I are on the same team. We both share the same responsibility: to support the decision your family member has already made and provide the best care possible. We need to be together on this so let’s spend some time talking it through.