How Can A Doctor Improve the Delivery of Life-Shattering News?
How do pediatric hospitalists — physicians who specializes in treating hospitalized patients— prepare for serious illness conversations with parents? How do they manage when parents respond silent in shock, heated in anger, or steeped in denial? Whether a pediatric hospitalist has had years of experience or a pediatric resident has only been on hospital floors for a few months these conversations are some of the most challenging interactions.
During the first New England Pediatric Hospital Medicine Conference sponsored by Partners Healthcare, pediatric hospitalists trained as facilitators reviewed the goals of the Continuum Project, a MassGeneral Hospital for Children initiative that guides doctors as they: 1) open the conversation with parents about palliative care for their child, 2) assess the prognostic awareness of the parents, 3) share the parents’ concerns, 4) align themselves with parents toward the common goal of compassionate care for their patients, 5) explore what’s most important in the “big” picture, e.g. time spent with family or friends or maintenance of the child’s quality of life, and 6) after discussing the parents’ priorities offer a recommendation for future care.
With these goals in mind, small groups assembled each with a facilitator, several hospitalists, and a parent volunteer. I agreed to be a parent volunteer because I know acutely what it is like to be the parent receiving life-changing news and because denial was no stranger to me. In the first role play, I was a mother deep in denial about the life-expectancy of my child. The hospitalist opened up the conversation gently but directly hoping that I would absorb my child’s prognosis. But, in my role, I fiercely resisted registering the severity of my child’s condition. This gave the hospitalist the opportunity to practice how to respond to my emotion, how to explore options for connecting with me, and how to try to develop a sense of trust that we were both on the same side trying our best to give my child the best quality of life she could have in her remaining months of life. In my second role, I was a mother outraged in anger after receiving the news of my child’s dire condition. The hospitalist practiced many of the similar methods of how to acknowledge and handle my emotion, connect with me, and generate conversations to lead us to work together as a team.
I applaud MassGeneral Hospital for Children for developing this protocol for talking with parents whose child has a serious illness and needs palliative care. These real-life conversations are extremely challenging for every doctor and excruciating for each parent. Any steps that can be taken to increase the effectiveness of a doctor’s delivery of life-shattering news and alter the terrifying process for a grief-stricken parent will lead to improved parent and patient experiences.