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Palliative Care in Amyotrophic Lateral SclerosisFrom Diagnosis to Bereavement, 3rd Edn$
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David Oliver, Gian Domenico Borasio, and Wendy Johnston

Print publication date: 2014

Print ISBN-13: 9780199686025

Published to Oxford Scholarship Online: May 2014

DOI: 10.1093/acprof:oso/9780199686025.001.0001

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Communication: breaking the news

Communication: breaking the news

(p.33) Chapter 3 Communication: breaking the news
Palliative Care in Amyotrophic Lateral Sclerosis

Richard Sloan

Gian Domenico Borasio

Oxford University Press

Breaking the news in ALS is not a standardizable procedure. However, proven techniques exist to reduce the trauma to the patient and ease the burden on the doctor. Information is best offered in a stepwise fashion at the patient’s pace with an emphasis on positive aspects and in the presence of the patient’s family. Reviewing available therapeutic options and current research efforts may foster hope for the future, while pointing out that almost all symptoms of ALS can be alleviated by palliative therapy may help to reduce fears. Encouraging patients to ask questions and disclose anxieties is important for their psychological well-being. Available options for mechanical ventilation should be reviewed early enough to allow for unhurried decision-making. The terminal phase of the disease should be discussed at the latest when dyspnoeic symptoms appear, in order to prevent unwarranted fears of ‘choking to death’.

Keywords:   breaking bad news, telling the diagnosis, patient–physician communication, empathy, collusion

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