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?

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 goal as r...

There is no true way, gradual explanation (over 2+ days) yields better comprehension than being upfront on the first encounter.