Transcript Module 11
The
TM
EPEC-O
Education in Palliative and End-of-life Care - Oncology
Project
The EPEC-O Curriculum is produced by the EPEC TM Project with major funding provided by NCI, with supplemental funding provided by the Lance Armstrong Foundation.
E P E C O EPEC – Oncology Education in Palliative and End-of-life Care – Oncology
Module 12 Conflict Resolution
Overall message Resolving conflict leads to better outcomes
Objectives
List factors that can lead to conflict
Understand How to identify common factors How to communicate and negotiate to resolve conflict directly The steps involved in fair processes to resolve intractable conflict
Video
Oncologists and conflict
Patients / families may be invested in interventions ‘I insist on further therapy’
Physicians / other professionals may be invested in interventions ‘I want to give more therapy’
Any party may perceive conflict
Conflict over treatment
Unresolved conflicts lead to misery Most can be resolved
Try to resolve differences
Support the patient / family
Base decisions on Best evidence, informed consent, advance care planning, goals of care
Root causes
Misunderstanding
Values
Personal factors
Inappropriate decision-maker
Misunderstanding of diagnosis / prognosis
Underlying causes
How to assess
How to respond
Misunderstanding: underlying causes . . .
Doesn’t know the diagnosis
Too much jargon
Different or conflicting information
Previous over-optimistic prognosis
Stressful environment
. . . Misunderstanding: underlying causes
Sleep deprivation
Emotional distress
Psychologically unprepared
Inadequate cognitive ability
Types of conflicts
Disagreement over Goals Benefits
Difference in values
Religious
Miracles
Value of life
Personal factors
Distrust
Guilt
Grief
Intra-family issues
Secondary gain
Physician / nurse
Criteria for selection of surrogate decision-maker. . .
Patient’s stated preference
Legislated hierarchy
Who is most likely to know what the patient would have wanted?
. . . Criteria for selection of surrogate decision-maker
Who is able to reflect the patient’s best interest?
Does the surrogate have the cognitive ability to make decisions?
A 7-step protocol to resolve conflict . . .
1.
Setting 2.
Perception What is known?
3.
Invitation Explore hopes and expectations
. . A 7-step protocol to resolve conflict 4.
Knowledge Attempt to resolve the conflict 5.
Emotion Respond 6.
Subsequent Make a plan and follow through 7.
Reassess and revise regularly
Misunderstanding: how to respond . . .
Choose a primary communicator
Give information in Small pieces Multiple formats
Use understandable language
Frequent repetition may be required
. . . Misunderstanding: how to respond
Assess understanding frequently
Do not hedge to “provide hope”
Encourage writing down questions
Provide support
Involve other health care professionals
When conflict persists
Seek assistance Consultants External facilitator Second opinion Ethics committee
When the team is the source of conflict
E P E C O
Summary Resolving conflict leads to better outcomes