{"title":"Pairing Hopes and Worries","authors":"J. Jacobsen, V. Jackson, J. Greer, J. Temel","doi":"10.1093/med/9780197525173.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780197525173.003.0002","url":null,"abstract":"This chapter describes the second challenge of serious illness, pairing hopes and worries. It discusses how clinicians help patients acknowledge worries and explains how, by pairing hopes and worries, patients can step outside of their moment-to-moment feelings enough to gain a broader perspective. This slight distance helps patients to see themselves with clarity and empathy. The chapter describes communication skills for helping patients pair hopes and worries and introduces clinical attunement, a specialist concept that includes aspects of attunement specific to palliative care: being aware of how the patient is coping and of the mostly likely illness trajectory. The chapter ends with skills for talking with oncology colleagues about how patients are learning to pair hopes and worries and to develop prognostic awareness.","PeriodicalId":337364,"journal":{"name":"What's in the Syringe?","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114951690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acknowledging End of Life","authors":"J. Jacobsen, V. Jackson, J. Greer, J. Temel","doi":"10.1093/med/9780197525173.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780197525173.003.0005","url":null,"abstract":"This chapter, “Acknowledging End of Life,” describes the fifth challenge of serious illness. It discusses how to have conversations about end of life with very sick patients. For some patients, these conversations include overt talk about dying. For others, these conversations may be indirect, using allusive talk or euphemisms. The chapter focuses on the importance of attunement in these conversations, which follow the pace of the illness and may happen before the patient is ready. It also explores how the possibility of the patient dying can create tensions within the medical team and ways in which these tensions can be eased.","PeriodicalId":337364,"journal":{"name":"What's in the Syringe?","volume":"29 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120839224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deepening Prognostic Awareness","authors":"J. Jacobsen, V. Jackson, J. Greer, J. Temel","doi":"10.1093/med/9780197525173.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780197525173.003.0004","url":null,"abstract":"This chapter describes the fourth challenge of serious illness, deepening prognostic awareness. It discusses how to hold conversations about the meaning of the prognosis. These conversations range beyond, and need not include, explicit prognostic disclosures. To engage in them, patients need distress tolerance: the capacity to experience oneself and the current situation without trying to change the situation. Then, through these conversations, patients develop and refine their inchoate worries and reprioritize their values. The chapter discusses, first, how to approach patients who can talk about the future (who more easily pair hopes and worries). It then explores the clinical dilemma of patients who hesitate to talk about the future. It discusses how to invite these patients into difficult conversations based on the clinician’s attunement to how the patient is coping and the illness trajectory. The chapter ends by discussing of how the collaboration between palliative care and oncology clinicians is affected by the patient’s deepening prognostic awareness.","PeriodicalId":337364,"journal":{"name":"What's in the Syringe?","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115945019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Living Well with Serious Illness","authors":"J. Jacobsen, V. Jackson, J. Greer, J. Temel","doi":"10.1093/med/9780197525173.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780197525173.003.0003","url":null,"abstract":"This chapter, “Living Well with Serious Illness,” describes the third challenge. In contrast to optimistic, longer-term hopes (e.g., for a cure) that rely on extraordinary medical fortune, living well applies to the near future and can start now. The chapter discusses how to help patients develop rich attainable hopes, even though their life is or will be limited by a serious illness. It describes what the authors have learned from their research into how coping skills help patients live well and discusses in detail the most important coping skills and how to teach them to patients. Supporting patients in living well improves quality of life and builds the partnership critical as the disesase progresses, when clinicians will help patients live well under ever changing circumstances. Thus, palliative care clinicians should spend most of their time with patients on this challenge.","PeriodicalId":337364,"journal":{"name":"What's in the Syringe?","volume":"45 3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115751543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adapting to the Diagnosis","authors":"J. Jacobsen, V. Jackson, J. Greer, J. Temel","doi":"10.1093/med/9780197525173.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780197525173.003.0001","url":null,"abstract":"This chapter describes the first challenge of serious illness, adapting to the diagnosis. It explores the beginnings of prognostic awareness (the patient’s understanding of his or her most likely disease trajectory and life expectancy) and discusses the seemingly confusing way that patients cope with a new cancer diagnosis: by swinging, as if they are on a pendulum, between moments of hope and moments of worry. It outlines how palliative care clinicians can help patients adapt to and cope with this life-changing news, thereby developing a partnership. The chapter also describes how palliative care clinicians can build an effective collaboration with oncology colleagues. It focuses on how to manage role overlap and the interpretive role of the palliative care clinician in helping the patient and the oncologist to understand each other.","PeriodicalId":337364,"journal":{"name":"What's in the Syringe?","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121885619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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