The Conversation: A Revolutionary Plan for End-of-Life Care

by Angelo E. Volandes, M.D. M.D. M.D.

Overview

In this "enlightening" (Jane Brody, New York Times) book, Harvard Medical School physician Angelo E. Volandes offers a solution to traumatic end-of-life care: talking, medicine's oldest tool.

There is an unspoken dark side of American medicine—keeping patients alive at any price. Two thirds of Americans die in healthcare institutions, tethered to machines and tubes at bankrupting costs, even though research shows that most prefer to die at home in comfort, surrounded by loved ones.

Dr. Angelo E. Volandes believes that a life well lived deserves a good ending. Through the stories of seven patients and seven very different end-of-life experiences, he demonstrates that what people with a serious illness, who are approaching the end of their lives, need most is not new technologies but one simple thing: The Conversation. He argues for a radical re-envisioning of the patient-doctor relationship and offers ways for patients and their families to talk about this difficult issue to ensure that patients will be at the center and in charge of their medical care.

It might be the most important conversation you ever have.

Product Details

ISBN-13:	9781620408544
Publisher:	Bloomsbury USA
Publication date:	01/13/2015
Pages:	240
Product dimensions:	5.90(w) x 8.30(h) x 1.10(d)

About the Author

Angelo Volandes is a physician, writer, and patients' rights advocate. He practices internal medicine at Massachusetts General Hospital in Boston, and is on faculty at Harvard Medical School. He is Co-Founder and President of Advance Care Planning (ACP) Decisions, a non-profit foundation implementing systems and technologies to improve the quality of care delivered to patients in the health care system.
Born and raised in Brooklyn, NY, he was educated at Harvard, Yale, and the University of Pennsylvania. He lectures widely across the country, and spends his time in Massachusetts with his wife Aretha Delight Davis, MD, JD and their two daughters.

Table of Contents

Note to Readers xi

Introduction: Death in America 1

Chapter 1 My Medical Odyssey 11

Chapter 2 "Do Everything" 32

Chapter 3 "We Never Kept Secrets from Bach Other" 51

Chapter 4 "Where Do We Go From Here?" 67

Chapter 5 "If a Picture Is Worth a Thousand Words…" 95

Chapter 6 Coming Home 116

Afterword: "No One Ever Asked Me What I Wanted" 139

Appendices

I Starting The Conversation (for Patients) 145

II Taking Control and Completing Your Advance Directives 153

III Starting The Conversation (for Families) 161

IV Online Resources 165

Acknowledgments 167

Notes 171

Selected Bibliography and Further Reading 207

Index 211

Editorial Reviews

01/01/2015
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

Library Journal

2014-10-22
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 alternatives—e.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.

Kirkus Reviews

"A timely book, written with sensitivity, on a subject which pertains to every single human being and family in the world today." - Richard Selzer, MD, author of MORTAL LESSONS

"For too long, a conspiracy of silence has stood between Americans and the quality care they need, want, and deserve. The Conversation could change all that. Good quality care requires that the treatments are consistent with the values, preferences, and priorities of the people we serve. Now, through the stories in The Conversation, Dr. Volandes shows how skillful communication can make the best of even the hardest situations." - Ira Byock, MD, professor, Dartmouth's Geisel School of Medicine; Chief Medical Officer, The Institute for Human Caring; author of THE BEST CARE POSSIBLE and DYING WELL

"My encounter with Dr. Angelo Volandes changed the way I think about life's most precious weeks and hours, and gave me hope for a better future. Your encounter with this passionate humanitarian and the heartbreaking, inspiring stories he tells will affect you the same way." - Jonathan Rauch, Senior Fellow, The Brookings Institution

"Through seven stories of seven patients, Angelo Volandes movingly and evocatively tells the tale of how American healthcare does death wrong, often with tragic consequences, and how we can do it right. This is a book about how to live life as well as possible right up until the end, and it should be required reading for anyone who is mortal." - Shannon Brownlee, author of OVERTREATED

"Part memoir, part tales from the trenches, part guide, The Conversation shows how medicine fails patients with serious illness, then offers a different, better approach to improve not only how we die but—more importantly—how we live." - Louise Aronson, MD, Director, Northern California Geriatrics Education Center and UCSF Medical Humanities

"Volandes has done more than anyone to translate the incomprehensible and the unimaginable into clear visual terms for real human beings trying to decide how they want to be cared for in the future." - Diane Meier, MD, Director of the Center to Advance Palliative Care; Professor of Geriatrics & Palliative Medicine, Mount Sinai School of Medicine

"Worth the price of the book alone is Volandes’ easy-to-follow guide for determining and making known one’s end-of-life wishes." - Booklist

"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." - Library Journal

"Appropriately, Volandes neither attempts nor claims to be impersonal or unemotional about this charged topic; rather, he brings his personal and professional experiences as well as research to his impassioned argument . . . [He]makes his points succinctly and convincingly and offers readers the tools to make change within their own lives." - Shelf Awareness

"A thoughtful and thought provoking book that confronts the fear of death with the grace of wisdom and understanding." - Spiritualty and Health

"Enlightening." - Jane Brody, The New York Times

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