Journal of palliative medicine
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Communication with patients and families is an essential component of high-quality care in serious illness. Small-group skills training can result in new communication behaviors, but past studies have used facilitators with extensive experience, raising concerns this is not scalable. ⋯ A communication skills intervention using newly trained facilitators was associated with improvement in trainees' skills in giving bad news and expressing empathy. Improvement in communication skills did not vary by trainee characteristics.
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The communication skills of noticing emotional cues and responding empathically are necessary but insufficient for some conversations about redefining goals of care. For some patients, an empathic response by a clinician is insufficient to move the conversation forward. We describe an expert approach that links empathy to action. In this approach, we outline (1) how affect provides a spotlight that illuminates what is important, (2) how empathy affords a way to connect with patients and families that engages deep values, (3) how clinicians can infer deep values through an associative process with patients, and (4) how clinicians can then design actions with patients and families and nurture their commitment to the actions.
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Lung cancer is the leading cause of cancer-related death.(1) Accurate prediction of survival in the terminal stage is important, because it may help patients make a rational decision. Although several prognostic scores have been described as effective indicators of outcome, these scores were intended for patients with other types of cancers. There is no prognostic score for patients with terminal-stage lung cancer. ⋯ This study revealed that fatigue, anorexia, desaturation, hyponatremia, and hypoalbuminemia may be short-term prognostic factors in terminally ill lung cancer patients. In particular, the presence of more than three of these factors predicted death within two weeks.