Each year, Texas Children’s Heart Center honors its founder, Dr. Dan McNamara, with a grand rounds dedicated to pediatric cardiology. This year’s speaker was Dr. Chris Feudtner from Children’s Hospital of Philadelphia Department of Medical Ethics and the Pediatric Advanced Care Team. Feudtner spoke to a standing-room only audience of physicians at McNamara Grand Rounds in the Texas Children’s Hospital Auditorium. The subject of his talk, compassionate confrontations: integrating hopes, emotions and duties when confronting serious illness, was a message of giving care to families coping with difficult decisions and grim prognoses.
“Even though I am one of you and I like living and working at the hospital, no parents likes hospitals and we have to remember that,” Feudtner said. “When communicating with parents, we need to remember we’re all feeling beings who have thoughts.”
Feudtner gave several examples of relaying difficult news to patient families. He encouraged providers to ask parents their hopes for their child. Acknowledging that hope as well as the hopes that can be achieved.
“Don’t argue with someone’s hope. Respect and honor patient family’s hopes and allow them to share other hopes that can then help you with the course of action you take with their child’s care,” Feudtner said.
Feudtner suggested to thank parents for sharing their first hopes, which will almost always be false hope characterized by Feudtner as “duty-based hope” that allows parents to remain wishful that the prognosis will improve against all odds. His suggestion, acknowledge the importance of this hope and how as a caregiver, you too wish this were possible, but ask for other hopes which opens the door for dialogue.
“The parents then may say they hope their child is not in a lot of pain,” Feudtner said. “When the second and third hopes are shared, it’s easier for you to say ‘I can help with that.’”
Feudtner ended the conversation by encouraging the health care providers to be in partnering relationships with patients to move forward in care.