Ambiguity of Comfort Care Creates Confusion for Physicians, Patients Alike

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The term “comfort care” has generally become synonymous with end-of-life care in today’s healthcare environment.
The term “comfort care” has generally become synonymous with end-of-life care in today’s healthcare environment.

The term “comfort care” has generally become synonymous with end-of-life care in today's healthcare environment, but the use of this terminology may have undesirable effects on the wide-scale perception of what is truly detailed in such care. In a perspective article published in JAMA Internal Medicine, investigators describe the importance of clarifying the ambiguity associated with “comfort care” in current society.

According to Anne M Kelemen, LICSW, and Hunter Groninger, MD, of the section of palliative care at MedStar Washington Hospital Center in Washington, DC, the public may perceive comfort care as a means of controlling symptoms and soothing quality of life metrics, not medical treatment. In addition, comfort care “implies that those living with advanced illnesses — and all the physical, psychological, social, and spiritual aspects of the disease — must choose between life-extending therapies and experiencing relief.” Confusion and ambiguity about the terminology is prevalent among clinicians, as well as the lay public.

The vagueness of the term comfort care increases the risk that clinicians will forgo individualized care plans in lieu of any protocol that will ease symptoms. The lack of specification may result in treatment processes that go against values and goals of the patients and their families. To overcome this, the researchers suggest having thorough educational discussions with colleagues and families to consider every medication, imaging study, and laboratory test that will alleviate symptom burden at the end of life.

Accurate communication that is gentle and supportive is key for reducing ambiguity regarding comfort care health interventions and the terminology that accompanies these approaches. “Similar to the terms transition or pass on, when used without explanation, phrases such as ‘making [one] comfortable' or ‘focusing our care on comfort' run the risk of serving as misunderstood euphemisms for what this really is: high-quality end-of-life care,” the investigators wrote.

Reference

Kelemen AM, Groninger H. Ambiguity in end-of-life care terminology — what do we mean by “comfort care?” [published online September 4, 2018] JAMA Intern Med. doi:10.1001/jamainternmed.2018.4291

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