The population of the U.S is progressively becoming older; however, healthy aging is no longer an oxymoron. The availability of preventative medicine and health promotion programs have extended how long people can live healthy lives without chronic disability.
Those aged 65 and over are projected to reach 83.7 million by 2050 [PDF]. While modern medicine has become proficient at extending how long we enjoy good health, it cannot stop the inevitable progression of disease towards the end of life. Unfortunately, advances in medicine have not made the process of dying any easier. The lack of necessary resources to help patients reach decisions about their end-of-life (EOL) care in modern medicine might even be hindering the process.
As the U.S. population ages, there’s a concurrent need for healthcare providers trained in initiating and conducting EOL care conversations. These conversations are a vital step that allow patients to identify preferences and expectations regarding their medical care near death. A study published in the Journal of the American Medical Association evaluated the impact of EOL discussions among terminally ill cancer patients and found that those who engage in EOL discussions with their provider are more likely to accept their diagnosis, receive fewer aggressive treatments, and experience better quality of life in the last week of life.
Communication about EOL care is beneficial; however, these discussions are not happening. Providers often lack the training and skills to have these conversations or feel uncomfortable with the topic. A systematic review of 20 articles on EOL care communication identified some of the common barriers to such discussions:
1) Physicians primarily discuss medical/technical issues as opposed to emotional issues,
2) Emotional and sensitive discussions require more physician time, and
3) Physicians guide and dominate patient conversations, which is problematic if they don’t bring up EOL care.
One method of enhancing patient-provider communication, and ultimately enhancing EOL care discussions, is through the practice of empathy. Empathy, previously dismissed as “good bedside manner,” is now considered an important component to establishing trust and building a positive patient-provider relationship. As opposed to feeling sorry for a patient, empathy allows providers to stand in the patient’s shoes and gain a better understanding of the situation from the patient’s perspective. Thankfully, empathy is a skill that can be taught! While lessons on how to be more empathetic typically aren’t part of the medical training curriculum, programs such as “Empathetics” (a series of online courses that focus on teaching empathy) are becoming more prevalent among healthcare organization and providers.
On a more personal note, our group at RTI International (a non-profit research institute) has also been working to create an innovative and accessible solution to teach empathy. We are developing a smartphone-based mobile app for medical trainees and providers. The goal of the app, which will use virtual reality technology, is to help providers increase their skills in discussing emotional or sensitive topics and gain empathy for patients nearing the end of their life. Through the immersive nature of virtual reality, the app will allow users to experience the patient’s perspective firsthand and understand what it’s like to be in their shoes. The hope is that providers who use the training will be able to enhance their skills in discussing emotional or sensitive topics surrounding EOL care. Ultimately, encouraging EOL conversations will help patients reach more informed decisions about their care.
If you’re interested in some additional information on how virtual reality is being used here at RTI, check out this interview with Laura Wagner, MPH on The Measure of Everyday Life.