EMCrit Podcast EMCrit Podcast 276 - End of Life Conversations with Kei Oichi
Jun 25, 2020
Kei Ouchi, an emergency physician who studies palliative care and goals-of-care communication, talks about practical steps for end-of-life conversations in the ED. Short, structured approaches are discussed: asking what families know, breaking bad news clearly, assessing baseline function, eliciting precise values, offering patient-centered recommendations, and using time-limited trials to balance dignity and treatment.
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Chapters
Transcript
Summarize To Verify Alignment And Build Trust
- Summarize what you heard to check alignment and make surrogates feel heard.
- Use phrasing like "What I heard you say is... I get that right?" to improve trust and shared understanding.
Give A Recommendation Based On Values And Prognosis
- Make a patient-centered recommendation based on prognosis and the patient's values rather than offering neutral choices.
- Recommend for intubation if best-case outcome fits values, recommend against if best-case is worse than dying.
Offer A Time Limited Trial To Reassess
- Use time-limited trials when appropriate: offer a short ICU trial (eg 24 hours) to reassess and align ongoing care with evolving prognosis.
- Frame it as a temporary plan and schedule reassessment with ICU clinicians.