What are the challenges of end-of-life care for the provider?
Deciding when to make the transition from curative/restorative mode to one of comfort measures only and having the skills to communicate this to the patient are probably the greatest challenges facing the provider (see Table 15-3). While guidelines exist for having difficult conversations effectively, avoiding conveying a message of abandonment is the real difficulty. Being adept at managing symptoms such as pain can give the provider confidence when initiating this conversation. Reassuring the patient and family that comfort measures are always possible and isolating one problem at a time may minimize their sense of being overwhelmed. Simply asking the patient what goals are important helps refocus on concrete issues that can be successfully mastered. Another significant challenge for the provider may be foregoing invasive diagnostic studies when the patient is moving closer to death. The astute practitioner needs to rely on physical assessment and knowledge of probabilities to surmis
