OET Rx (Student Pre-Class)
Lesson 23: Discussing End-of-Life Care Options
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Course Progress
Part 1: Lesson Objectives
By the end of this lesson, you will be able to:
- Initiate a sensitive conversation about end-of-life care with a patient and their family.
- Explain different care options, such as palliative and hospice care, in a clear and empathetic way.
- Explore a patient's values, wishes, and goals of care.
- Understand the concept and importance of Advance Care Planning (ACP).
Part 2: Vocabulary & Examples
General Vocabulary
legal /ˈliːɡl/:
قانونی
A Living Will is a legal document that ensures a patient's wishes are respected even if they lose the capacity to communicate.
length /leŋθ/:
طول، مدت
Our focus is shifting from the length of life to the quality of the life that remains.
less /les/:
کمتر
We can offer treatments that are less aggressive and more focused on your comfort.
let /let/:
اجازه دادن
Please let me know what is most important to you as we plan for your future care.
letter /ˈletər/:
نامه
Some patients write a letter of wishes to guide their family and doctors in the future.
level /ˈlevl/:
سطح
We need to have an honest conversation about the current level of your illness and what to expect next.
life /laɪf/:
زندگی
Our primary goal now is to ensure the best possible quality of life for you.
lifestyle /ˈlaɪfstaɪl/:
سبک زندگی
We need to discuss how your current lifestyle might change and what support you will need.
light /laɪt/:
نور، جنبه
In light of the recent scan results, I think it is important that we discuss your future care preferences.
like /laɪk/:
مانند، مثل
There are several options, like hospice care at home or admission to a palliative care unit.
likely /ˈlaɪkli/:
محتمل
It is likely that your symptoms will progress, so planning ahead is a sensible step.
limit (n.) /ˈlɪmɪt/:
محدودیت
It is important to understand the limit of what curative treatments can now achieve.
limitation /ˌlɪmɪˈteɪʃn/:
محدودیت
Acknowledging the limitations of treatment allows us to refocus on the goals of care.
limited /ˈlɪmɪtɪd/:
محدود
Since further chemotherapy would have limited benefit, I recommend we focus on symptom control.
line /laɪn/:
خط، مسیر
This conversation marks a shift to a different line of care, one focused entirely on comfort.
link /lɪŋk/:
ارتباط دادن
We can link you with our palliative care team, who are experts in this area.
list /lɪst/:
فهرست، لیست
Let's make a list of what is most important to you; for example, being at home, or being pain-free.
listen /ˈlɪsn/:
گوش دادن
My most important job right now is to listen to you and understand your wishes.
little /ˈlɪtl/:
کم
We will do everything to ensure you have as little pain as possible.
live /lɪv/:
زندگی کردن
The goal of palliative care is to help you live as well as possible for as long as possible.
living /ˈlɪvɪŋ/:
زندگی، در قید حیات
A living will is a document that speaks for you when you are no longer able to.
local /ˈloʊkl/:
محلی
We can arrange for the local community hospice team to visit you at home.
Medical Vocabulary
Advance Care Plan (ACP) /ədˈvɑːns ker plæn/:
برنامه مراقبت پیشرفته
An Advance Care Plan allows you to state your preferences for treatment in the future, which can be a great gift to your family.
DNACPR (Do Not Attempt CPR) /ˌdiːenˌeɪsiːpiːˈɑːr/:
عدم احیای قلبی ریوی
We need to discuss a DNACPR order; this is a decision about avoiding invasive procedures that are unlikely to be successful at this stage of your illness.
End-of-life Care /end əv laɪf ker/:
مراقبت پایان زندگی
The focus of end-of-life care is to ensure a person dies with dignity and in comfort.
Goals of Care /ɡoʊlz əv ker/:
اهداف مراقبت
Before we discuss specific treatments, it is essential to understand your goals of care. What is most important to you now?
Holistic Care /hoʊˈlɪstɪk ker/:
مراقبت جامع‌نگر
Palliative medicine provides holistic care, involving doctors, nurses, social workers, and spiritual advisors.
Hospice Care /ˈhɒspɪs ker/:
مراقبت آسایشگاهی
Hospice care can be provided at home, in a care home, or in a dedicated hospice facility.
Living Will /ˈlɪvɪŋ wɪl/:
وصیت‌نامه زنده
Your living will clearly states that you would not want to be kept alive on a ventilator.
Quality of Life /ˈkwɒləti əv laɪf/:
کیفیت زندگی
Our focus now is entirely on your quality of life, which means managing your symptoms so you can enjoy your time.
Symptom Control /ˈsɪmptəm kənˈtroʊl/:
کنترل علائم
Excellent symptom control for pain and nausea is our immediate priority.
Terminal Illness /ˈtɜːrmɪnl ˈɪlnəs/:
بیماری لاعلاج/پایانی
A diagnosis of a terminal illness is devastating, and our team is here to support you and your family.
Part 3: Pre-Class Practice Tests
Reading Task (Longer & More Professional):
Excerpt from "The Journal of Nursing Ethics"
Title: The Nurse as Advocate in Advance Care Planning
Advance Care Planning (ACP) is a process of communication between a patient, their family, and their healthcare providers. Its aim is to clarify a patient's values and preferences for future medical treatment. While ideally initiated by a doctor in an outpatient setting, nurses are frequently the ones who facilitate these complex conversations, particularly in hospital or community care environments. The nurse's role as a patient advocate is paramount in this context. It involves creating a safe space for the patient to explore their wishes, which may be different from what their family desires.
A significant challenge arises when there is a conflict between the patient's stated wishes and the family's expectations. For example, a patient may articulate a clear desire to refuse life-sustaining treatment, while their family may insist that "everything must be done." In this scenario, the nurse's legal and ethical duty is to the patient. The nurse must gently but clearly advocate for the patient's autonomy, provided the patient has the mental capacity to make such decisions. This involves careful documentation of the ACP conversation and ensuring the written plan is clearly visible in the patient's medical file.
Facilitating ACP discussions can be emotionally demanding for nurses. It requires advanced communication skills, a deep understanding of medical ethics, and significant emotional resilience. Healthcare institutions have a responsibility to provide nurses with adequate training and structured debriefing support. Without this institutional support, there is a risk of moral distress and burnout among staff who are regularly engaged in this essential, yet emotionally heavy, aspect of holistic care.
Question: What does the author state is the nurse's primary responsibility when a family's wishes conflict with those of a patient who has capacity?
Listening Task (Part A Simulation):
Scenario: You will hear a palliative care doctor helping a patient fill out a section of their Advance Care Plan.
Task: Complete the notes on the form. Write one or two words for each gap.
Advance Care Plan: Patient Preferences
Patient Name: (1)
Primary Goal for Future Care: To be as (2) as possible.
Preferred Place of Care: At (3)
Specific Refusal of Treatment: Does not want (4)
Nominated person for discussions: His wife, (5)
Part 4: Answer Key for Pre-Class Work
Reading Answer: c) To uphold the patient's wishes and act as their advocate.
Listening Answers: (1) John Miller, (2) comfortable / pain-free, (3) home, (4) artificial feeding / tube feeding, (5) Susan
Part 5: In-Class Preparation
This section is designed specifically for doctors. Be prepared to discuss the vocabulary and practice the following tasks in class.
Speaking Task: OET Role-Play Card (Medicine)
Setting: A quiet room in a hospital.
Patient: A 75-year-old patient with advanced, incurable lung cancer whose condition is deteriorating. They are accompanied by their adult child. They are aware their illness is terminal.
Task:
- Gently initiate a conversation about planning for the future.
- Explore the patient's goals of care (e.g., "As we think about the coming weeks and months, what is most important to you?").
- Based on their goals, explain the different options for their end-of-life care (e.g., remaining in hospital, moving to a hospice, or receiving hospice care at home).
- Discuss the pros and cons of each option in relation to their stated wishes.
- The goal is to start the conversation, not necessarily to make a final decision today.
Writing Task:
You are the doctor from the speaking scenario. Following this sensitive conversation, you must write a detailed entry in the patient's medical record. Document that the "Goals of Care" discussion took place, who was present, the patient's stated wishes (e.g., "priority is comfort and being at home"), and the options that were discussed.