From the Department of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
Authors’ disclosures of potential conflicts of interest are found at the end of this article.
Address reprint requests to Lidia Schapira, MD, Massachusetts General Hospital, Yawkey 9A, 55 Fruit St., Boston MA 02114; e-mail: lschapira{at}partners.org
Overview: Responding to requests that run counter to personal beliefs or clinical recommendations requires strategy and a particular skill set. The overarching goal is to negotiate a solution that serves the patient well and minimizes conflict, frustration, and tension. Examples common in oncology involve requests for intravenous nutrition, dialysis, or intubation for patients who are dying or decisions made based on uncertain prognosis. Clinicians may experience stress, tension, or frustration and must distinguish between different cognitive and value orientations. Consultation with experts in religion or ethics may help the patient and the medical team to clarify the issues at stake and pave the way for a negotiated solution. Religion, culture, and experience influence patients and clinicians. Doctors need clarity, humility, and imagination to support patients in desperate situations where the emphasis is on what really matters to the patient.
