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Making decisions more patient centred
A patient centred discussion should help to most closely match a patient’s wishes. In their Cochrane review article Lewin et al (2001) found that the effectiveness of interventions to improve patient centredness was only partly proven. Interventions varied, but included training for the providers in communication skills, problem defining skills training, humanistic and empathic behaviour, consultation structuring and recognition of psychological issues, materials for patients and patient centred training. None of the interventions involved palliative care patients or patients with impaired capacity. Whist it is useful for our discussion to know such interventions could be effective further evidence is necessary for palliative care patients and in particular to validate interventions or tools to use in discussing sedation at the end of life.
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