Lynn Black's mother-in-law, who had lupus and lung cancer, was rushed into a hospital intensive care unit last summer with shortness of breath. As she lay in bed, intubated and unresponsive, a parade of doctors told the family "all good news."
A cardiologist reported the patient's heart was fine. An oncologist announced that the substance infiltrating her lungs was not cancer. An infectious-disease doctor assured the family, "We've got her on the right antibiotic."
With each doctor's report, Black recalled, most of her family "felt this tremendous sense of relief."
But Black, a doctor herself, knew the physicians were avoiding the truth: "She's 100 percent dying."
"It became my role," Black said, to tell her family the difficult news that her mother-in-law, who was in her mid-80s, was not going to make it out of the hospital alive. Indeed, she died there within about a week.
The experience highlights a common problem in medicine, Black said: Doctors can be so focused on trying to fix each ailment that "no one is addressing the big picture."
Now Black, along with hundreds of clinicians at Massachusetts General Hospital in Boston, is getting trained to talk to seriously ill patients about their goals, values -- and prognoses -- while there's time to spare.
The doctors are using a script based on the Serious Illness Conversation Guide, first created by Drs. Atul Gawande and Susan Block at Ariadne Labs. Since its inception in Boston in 2012, the guide has been used to train over 6,500 clinicians worldwide, said Dr. Rachelle Bernacki, associate director of the Serious Illness Care Program at Ariadne Labs.
At Mass General, Dr. Juliet Jacobsen, a palliative care physician, serves as medical director for the Continuum Project, a large-scale effort to quickly train clinicians to have these conversations, document them and share what they learn with one another. The project ramped up in January with the first session in a series that aims to reach 250 primary care providers at the hospital.
For patients with advanced cancer, end-of-life conversations with clinicians take place a median of 33 days before a patient's death, research shows. When patients have end-stage diagnoses, fewer than a third of families recall having end-of-life conversations with physicians, another study found.