November 10, 2014 / 5:15 PM / 5 years ago

Meeting encourages more comprehensive end-of-life care

(Reuters Health) - Physicians turned to contemplative techniques last week in New York to learn how to improve end-of-life care and handle the stress, burnout and communication challenges faced in caring for seriously ill patients.

“There are skills that are not often talked about in medical schools that can be taught and learned, and it begins with self-care and developing empathy for one’s self,” said Robyn Brentano, executive director of the Garrison Institute in Garrison, New York.

The Institute, overlooking the Hudson River, is housed in a former Capuchin monastery and hosted close to 200 attendees at its symposium on communication and the interpersonal relationship within palliative and end-of-life care.

The conference centered on developing compassion and mindfulness among practitioners, so they may be more “fully present” with patients coping with physical, emotional and existential struggles often accompanying one’s final days, Brentano said.

Dr. Ira Byock, chief medical officer of the Providence Institute for Human Caring, considered the gathering a “master class” to discuss deeper levels of caregiving strategies.

“The entire culture of health systems approaches illness and dying through the lens of a medical problem,” Byock said. “But illness and dying are deeply personal experiences for the individual who is ill and the people that love that person.”

An Institute of Medicine (IOM) report released this fall - titled Dying in America - cited deficiencies in education and development among end-of-life care providers nationwide. The knowledge base of all clinicians needs improvement, according to the IOM, and is in urgent need of translation to bedside care.

Byock instructed attendees in the therapeutic use of imagination. The techniques are aimed at helping the providers perceive opportunities for growth during the end of life.

“We can look at the future as if we were shoulder to shoulder with a patient on a journey neither of us could choose,” Byock said. “Perceiving what is possible to have value or meaning to the person without it in any way discounting or diminishing the unwanted fact they can’t reverse the illness.”

That imagination often relies on narrative techniques in medicine, such as soliciting a patient’s life story to discern what inspires his or her individual life with value and meaning.

Narrative medicine is a field pioneered by Columbia University professor and physician Rita Charon, who is asking attendees to better recognize what their patients may hold central.

“To the extent we can recognize something about patients, we get recognized back,” Charon said. “That’s where the joy comes from for us. It’s not just counting lung nodules on the x-ray. It’s being present in the room with the patient and making things better. It’s not always what we can fix with a pill or another radiation treatment.”

Sometimes, the death experience can be improved with attention to the aesthetics surrounding the patient, says BJ Miller, a hospice and palliative physician and executive director of the San Francisco-based Zen Hospice Project. The attention to design in a patient’s environment is something he is asking providers to notice and improve.

“So much is stripped away, but what you are really left at the moment you die is some sensory input,” Miller said.

An open window, fresh cut flowers and photographs displayed in patient rooms are all details that care providers can incorporate without much effort or expense, Miller said. The consideration of such small touches could help patients feel greater belonging in their environments and more comfortable.

“There is more and brighter capacity within the experience of professional caregiving and the experience of living and dying than our American culture currently recognizes,” Byock said. “That is a conversation our culture desperately needs to have. The human capacity for well-being during illness and dying is an open secret that should be the next big idea in our culture.”

Brentano predicted a positive effect on care nationwide from the meeting, as attendees represented healthcare institutions from across the country and are charged with fostering these skills among colleagues at home.

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