The document discusses communication and decision making near the end of life. It provides statistics on hospital deaths and quality of end of life care in Canada. It emphasizes the importance of communication between physicians and patients, and outlines principles for discussions around end of life issues, including assessing understanding and goals, developing care plans, and providing closure.

1. Communication and Decision Making Near the End of Life Dalhousie Critical Care Lecture Series

3. Dying in Canada: Is it an Institutionalized, Technologically Supported Experience? Proportion of Hospital Deaths in 1997 Heyland Journal of Palliative Care 2000;16:S10

4. Proportion of Hospital Deaths in a ICU Dying in Canada: Is it an Institutionalized, Technologically Supported Experience? Heyland Journal of Palliative Care 2000;16:S10

5. “ Welcome to God’s waiting room!”

6. What is Quality End of Life Care?

7. Quality of End of Life Care in Canada Results from Patient’s Perspective N= 440 Heyland CMAJ 2006;174:627 41.8 To have an adequate plan of care and services available to look after you at home upon discharge 41.8 To not be a physical or emotional burden on your family 43.9 To complete things and prepare for life’s end 44.1 That information about your disease be communicated to you in a honest manner 55.7 Not to be kept alive on life support when there is little hope for a meaningful recovery 55.8 To have trust and confidence in the Doctor looking after you % “Extremely Important ” Areas of Greatest “Importance”

8. Quality of End of Life Care in Canada Results from Family Member’s Perspective N= 160 Heyland CMAJ 2006;174:627 69.4 To have an adequate plan of care and services available to look after you at home upon discharge 68.1 That your family member not be kept alive on life supports when there is little hope of recovery 70.6 That information about your disease be communicated to you in a honest manner 70.6 That your family member has relief of physical symptoms 74.4 To have trust and confidence in the Doctor looking after you % “Extremely Important ” Areas of Greatest “Importance”

15. Models Describing Patient- Physician Relationships Active Role Shared Passive Role Patient Decides Physician Decides

19. Patient Preferences for Decisional Responsibility Per cent Heyland Chest 2006

20. Who Would You Like to be Involved? Per cent Heyland Chest 2006 (in press)

21. Substitute Decision Makers’ Preferences for Decisional Responsibility Per cent n=789 Heyland Int Care Med 2003;29:75

23. ME Let Decide What do you want us to do? US Let Decide

24. End-of-life discussions should not be like a fast food restaurant menu