When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?
The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of improvement in overall survival and warnings about the risk of infection and LFT abnormalities seems less compelling to patients than the idea of starvation.
Answer from: Medical Oncologist at Academic Institution
This is such a tough question with no great answer. With any difficult conversation like this, I usually take this approach:
1) Understand what the patient's goals are. ("What's most important to you?")
2) Usually they say living as long as possible/as well as possible
3) Acknowledge that g...
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Answer from: Medical Oncologist at Community Practice
There is no true way, gradual explanation (over 2+ days) yields better comprehension than being upfront on the first encounter.