From the Editor: End-of-Life Conversations and Myths About Terminal Illness
End-of-life conversations between health care providers and family members of terminally ill patients are often fraught. Relatives, at one of the most challenging points in their lives, may not be equipped for the painful conversations and may be unable to absorb information, especially that which conflicts with their longstanding assumptions—ideas often based on misconceptions. These misunderstandings can lead to inadequate patient care and needless suffering.
Families, for example, may object to the use of morphine to suppress pain, improve breathing, and quell existential fear because they’ve been told it hastens death. Patients, thus, may suffer unnecessarily, both from pain and from the anxiety they may feel as they approach the end of their lives. Family members may worry about overdoses and side effects, or be troubled by drowsiness or hallucinations. They fear shortening what little time they have left to share. And although providers may try to educate them, they may not be able to accept the information or may do so reluctantly or guiltily. They need to be encouraged to understand that adequate pain control—comfort—is the key task of care for their terminally ill family member, and that morphine, when given appropriately, does not contribute to an earlier death.
Similarly, family members may worry when their relative loses interest in eating and drinking. They may insist on the use of IV fluids and tube feedings, fearing that the lack of sustenance will cause suffering. In this issue’s feature “Diminished Appetite at End of Life,” Scott Janssen, a hospice social worker, explores the research and discusses the strategies that can put families at ease while ensuring the greatest degree of comfort for their loved ones.
Also in this issue, Mark Coggins looks at the latest research on sleep apnea, Sandeep Kaur Dhillon traces the relationship between the endocannabinoid and gastrointestinal systems, and Lindsey Getz examines the underrecognized differences in heart disease between men and women.