End of life care is always associated with fundamental questions that can hardly be answered in many ways. Patients often feel depressed and unable to make decisions while healthcare professionals may also lack the necessary knowledge and health to ensure the high-quality end of life care. The insufficient knowledge of healthcare professionals is deeply rooted in the gap of the entire healthcare system and the western view of such aspects as medicine and end of life. The US healthcare system can be characterized by the focus on the assessment of people’s independence and ability to care about themselves (Gawande, 2014).
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For instance, when it comes to end of life care, an elderly person who is unable to perform some tasks (dress, use the toilet, and so on) is likely to be institutionalized. Another peculiarity of the system is its lack of attention to patients’ desires, fears, and concerns. Healthcare professionals tend to concentrate on available options that can potentially address the patient’s health conditions rather than discuss what the patient actually needs (Azvolinsky, 2016). Dr. Atul Gawande has come up with five important questions to be asked to manage a conversation with a patient that can ensure the provision of truly high-quality care characterized by respect, dignity, and comfort. This paper includes a brief description of the five questions and possible implications to address the gaps existing in the healthcare system and the overall society.
First, it is necessary to unveil the gaps in the system associated with end of life care. It has been acknowledged that end of life care is associated with the lack of communication skills and commitment to patients’ desires and needs. Healthcare professionals often try to avoid hard conversations concerning end of life care as they simply find them too difficult to manage and lack the necessary skills. On the other hand, American healthcare professionals focus on the medical part of the issue trying to come up with treatment plans and clinical procedures instead of asking the patient about their desires. The crisis may come unexpectedly or be anticipated, but patients and their caregivers are often unprepared.
Thus, instead of spending more time with the family or contemplating in a cozy place, patients have to spend their precious time (and even last moments) undergoing treatment. This situation is unacceptable as the patient’s desire should be the cornerstone of end of life care (Gawande, 2014). Patients should voice their ideas and wishes concerning their last years, months, and days. Gawande (2014) claims that patients can find it difficult or even impossible to hear themselves so the healthcare professional should help the patient to understand what their end of life care should be.
Dr. Atul Gawande developed five questions that can help address the issues mentioned above. The five questions are as follows:
- What is your understanding of where you are and of your illness?
- Your fears or worries for the future?
- Your goals and priorities?
- What outcomes are unacceptable to you? What are you willing to sacrifice and not? And later,
- What would a good day look like? (as cited in Campbell, 2015, para. 16)
These questions can start and guide the hard conversation healthcare professionals and caregivers often fear. These questions are effective as they address the most important aspects associated with end of life care. The first question helps the doctor and the patient start the conversation. The doctor and the patient discuss the health condition and the patients’ ideas concerning the overall situation. The next question helps the patient share their fears and concerns. The doctor should know about them to consider them when developing the most effective and appropriate treatment. The third question is central as it focuses on the patient’s priorities. This question helps the doctor and, more importantly, the patient outline the patient’s major priorities.
This question is often ignored, but it is vital for the psychological and emotional wellbeing of the patient. The fourth question is closely connected with the third one, but it concentrates on the other side of the issue. The patient outlines things that are unacceptable. Finally, the fifth question helps the doctor better understand what the patient really needs and seeks for. This question also helps the patient improve their emotional state as positive thinking and pleasant thoughts can help the patient address their health condition. Importantly, Gawande stresses that it is essential to continue asking patients as they often “change their minds” (Campbell, 2015, para. 20).
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In conclusion, it is necessary to note that the American healthcare system has various gaps associated with the provision of end of life care. Doctors and patients, as well as their caregivers, are unprepared to discuss important issues and fail to take into account patients’ true needs. Gawande’s five questions help doctors manage the hard conversation and elicit the most important information that can help develop the most effective and beneficial treatment for the patient. Healthcare professionals can use the five questions in their practice. These questions will help ensure the patient’s comfort and proper emotional state during last years, months, days, and even moments of their life.
Azvolinsky, A. (2016). Ask early and often: Offering better palliative care. Journal of the National Cancer Institute, 108(1), 1-7.
Campbell, S. (2015). Atul Gawande’s 5 questions to ask at life’s end.
Gawande, A. (2014). Being mortal. New York, NY: Henry Holt and Company.