Communication between patient and caregiver

The last communications of a dying person may be valued as the most important in a lifetime. Similarly, the decisions a person makes, including medical care decisions, as he or she negotiates the last chapter of life may be so meaningful that they are remembered for the rest of the lives of the bereaved. On a concrete level, care near the end of life can be so costly that the surviving family may shoulder the consequences for years or even generations. With decisions of such significance, communication of the information and other factors that go into them and communication of the decisions themselves, should be clear and reliable. And yet, communication at a time of serious illness and high emotions is both notoriously difficult and often further complicated by social taboos and interpersonal dynamics. This chapter identifies communications of importance and reviews some of the mechanisms involved in processing and managing them. The goal is to provide clinicians, patients, and their families and communities with a framework for understanding the issues, and with approaches that can optimize communications near the end of life.