The conversation A revolutionary plan for end-of-life care

Angelo Volandes, 1971-

Book - 2015

"There is an unspoken dark side of American medicine: keeping patients alive at all costs. Two thirds of Americans die in healthcare institutions tethered to machines and tubes, even though research indicates that most prefer to die at home in comfort, surrounded by loved ones. The question 'How do you want to live?' must be posed to the seriously ill because they deserve to choose. If doctors explain options--including the choice to forego countless medical interventions that are often of little benefit--then patients can tell doctors how they wish to spend the remainder of their lives"--Provided by publisher.

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Subjects
Published
New York : Bloomsbury 2015.
Language
English
Main Author
Angelo Volandes, 1971- (author)
Edition
First U.S. edition
Physical Description
220 pages : illustrations ; 22 cm
Bibliography
Includes bibliographical references (pages 207-209) and index.
ISBN
9781620408544
  • Note to Readers
  • Introduction: Death in America
  • Chapter 1. My Medical Odyssey
  • Chapter 2. "Do Everything"
  • Chapter 3. "We Never Kept Secrets from Bach Other"
  • Chapter 4. "Where Do We Go From Here?"
  • Chapter 5. "If a Picture Is Worth a Thousand Words..."
  • Chapter 6. Coming Home
  • Afterword: "No One Ever Asked Me What I Wanted"
  • Appendices
  • I. Starting The Conversation (for Patients)
  • II. Taking Control and Completing Your Advance Directives
  • III. Starting The Conversation (for Families)
  • IV. Online Resources
  • Acknowledgments
  • Notes
  • Selected Bibliography and Further Reading
  • Index
Review by Booklist Review

Harvard medical researcher Volandes jumps into the current headline-worthy fray by advocating for patients having the right to make their own end-of-life decisions. Too often, he says, patients leave these decisions to their physicians, who, without a directive from the patient, will do what they have been trained to do: everything possible to prolong life. The result is that far too many people die after financially-bankrupting interventions have left them but shells of their former selves, hooked up to life-sustaining machines, alone in a hospital. When asked, most people opt for a quiet, dignified passing at home in their own beds. The way this disconnect occurs between what people want and what the medical profession provides is the focus of this book, with Volandes strongly recommending that patients and doctors have the conversation. Volandes believes that people should make their families and their doctors aware of what they want for their final days. Worth the price of the book alone is Volandes' easy-to-follow guide for determining and making known one's end-of-life wishes.--Chavez, Donna Copyright 2010 Booklist

From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Library Journal Review

Patients and doctors together all too frequently avoid one of the most important areas of health care: making advance decisions about care at the end of life. From both a personal and an evidence-based practice perspective, Volandes (Harvard Univ.; founder, Advance Care Planning Decisions) attempts to show both why these vital conversations need to happen and how to facilitate them. The subject has been of interest to the author throughout his career, and his research is among the most focused. Here he provides the stories of seven terminally ill patients who have dealt with making decisions in a variety of ways. His investigations, including a number of randomized controlled trials, have looked specifically at the use of videos that explain to patients what happens in three levels of care: life-prolonging, limited medical, and comfort. The trials reveal that neutral but informative videos combined with conversations with a physician leave patients better informed and more comfortable making their choices. Provided are three appendixes to help patients, physicians, and families begin the conversation. VERDICT Written with passion and clarity, this book moves beyond others on the topic by including empirical evidence of how to make such conversations about end-of-life care most effective.-Richard Maxwell, Porter Adventist Hosp. Lib., Denver (c) Copyright 2015. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review

Harvard Medical School researcher Volandes, founder of Advance Care Planning Decisions, draws the curtain aside to reveal the painful realities of dying in a hospital setting.Despite tremendous advances prolonging life, writes the author, "[b]y most accounts, [the] transformation of death from a natural process occurring at home to a medicalized event taking place outside the home has been disastrous." Volandes explores the options open to patients and their families. Taking examples from his experiences as a physician, he describes how his perspective changed over time and how he has been able to help families make tough end-of-life decisions. Helping patients and their families anticipate their choices is important. Therefore, it is necessary to have an open conversation in advance regarding the alternativese.g., painful medical intervention to extend life or palliative treatment to ease a patient's last moments. "Without this open conversation about death," writes the author, "patients are traumatized needlessly, leaving their families with the emotional scars of witnessing hyper-medicalized deaths of their loved ones." Volandes references surprising results from a 2007 research study showing that patients who chose palliative care actually lived longer. He also cites a 2008 study that involved 332 patients who were suffering from advanced cancer. "The researchers found no evidence of distress or psychiatric illness in patients who had end-of-life discussions with their physicians," he writes. Volandes describes how he prepared patients and their proxies for the kinds of decisions they would face as they sought an optimal balance between prolonging life and palliative care. In many cases, he would take them to intensive care units to witness end-of-life treatment. In the appendices, the author offers guidelines and resources available to families facing difficult end-of-life decisions. A compassionate and informative treatment of a painful subject. Copyright Kirkus Reviews, used with permission.

Copyright (c) Kirkus Reviews, used with permission.