This question hits home for me. I recently sat down with the husband, and main caregiver, of a woman with advanced dementia. The woman eats very little and is losing weight despite her husband’s great efforts at encouraging her to eat. Under the care of another physician, she had been given megestrol acetate and there had been some improvement. Her visit to my office was an opportunity to continue an ongoing conversation with her husband about his wife’s overall decline, her advancing dementia, and the sorrow he was feeling over her failing health.
High-quality palliative care also requires special expertise in honest, compassionate communication. In addition to enhancing the patient's and family's experience, these skills help to establish trust and overcome barriers to adequate care and relief of symptoms. Several communication tasks are especially important: conveying accurate prognostic information while maintaining hope, eliciting information about symptoms, decision making about curative and palliative treatments, handling emotions, and dealing with requests from patients and families who have unrealistic goals [34, 35, 36] . The challenges of communicating effectively are discussed later in this course.
Most physicians will treat both issues simultaneously, since they are often linked. The first step in the treatment process, which is common for any substance abuser, is detoxification. This process will allow the body to cleanse itself of the alcohol or drug and physically heal. Ideally, the process of detoxification will take place with medical supervision, and it can take many days or even weeks to complete. With new developments in medication, doctors can reduce the pain of going “ cold turkey ” and ease substance abusers through the withdrawal period.