December 2012, Volume 42 Number 12 , p 10 - 11
My patient, "Irv," was recently diagnosed with advanced pancreatic cancer. He and his wife are trying to decide whether he should participate in a clinical trial. His healthcare provider has shared some positive statistics about increased length and quality of life associated with an experimental treatment for advanced pancreatic cancer. Irv and his wife agree that their main goal is to maintain his quality of life and enjoy their family.Their adult daughters have researched their father's condition online and believe they've found information that contradicts the healthcare provider's information. I checked out the research and have questions about some websites' reliability. How can I advocate for my patient without upsetting the family?-C.B., FLA.Encourage them to talk it out. These close and loving family members appear to have only Irv's best interests at heart. While the healthcare provider's recommendation may seem to contradict the daughters' information, their overall goals may not be in conflict if everyone agrees that this decision is ultimately Irv's to make.In some families, talking about impending death is a big taboo. Sometimes communication is the first casualty of a life-threatening illness. By encouraging talk time, you can lift the taboo and give everyone permission to share.Start the conversation by asking open-ended questions, such as, "What do you most want your family to know about you?" Encouraging talk time helps family affirm open, honest, face-to-face sharing of thoughts, hopes, and doubts before a crisis occurs. It can also help your patient and his family affirm their commitment to choices that can help ensure quality time for Irv.As for potentially untrustworthy websites, share reliable online resources and then ask the daughters to compare information from each site. Offer to answer questions they might have about the differences they notice in information from the various sites. Consider alerting Irv's healthcare provider about the daughters'