Palliative care or ‘end of life’ is always difficult to discuss. However, it is important that just as we want our loved ones cared for compassionately and thoroughly, that tests or treatments not be done when they don’t change the outcome or will cause suffering.  A number of patients who are about to die from advanced cancers or other life-ending diseases, end up in the intensive care unit receiving expensive, painful therapies that do not alter the outcome. Yet frequently, no discussion occurs ahead of time to map out what options exist, what would be beneficial or not, and what questions or opportunities the patient, their family, or their advocates want to address with their caregivers.

If we want to drive somewhere new, we plug the information into our GPS or search the web site map.  A plane would never take off without a plan in place. A company would never successfully run their business without a business plan. Yet when it comes to health care, frequently there is no map. In fact, a recent study in Journal of the American Medical Association by Sima et al (“Cancer Screening Among Patients With Advanced Cancer”, JAMA 2010; 304:1584-1591) found that a subset of patients with advanced cancers were subjected to screening tests which had no health benefit. An informed partnership between caregivers and patients/families can help ensure that a patient’s rights are respected and optimal care provided before being in a crisis situation.