"One of the most difficult issues in palliative care is how to address the decision-making when life comes to an end," stated Carole Robinson, Associate Professor  University of British Columbia (Canada) at the University of Navarra. The expert was one of the speakers of the course "Discovering the potential of qualitative research in palliative care", organized by the program ATLANTES of the Institute for Culture and Society (ICS).

Professor Robinson explained that she has done research regarding how to have these types of conversations with patients "in an environment where they feel supported, where they can express themselves and where they can speak to their families about their desires and where their hopes are not affected." These studies have helped her understand "that it is essential to know how patients understand their disease."

The expert said that throughout her experience with patients with advanced lung cancer she has observed through qualitative research methods that although these patients understand that treatment can simply slow down their symptoms, their hope for healing is strong.

"I've learned that if we know how they conceive their illnesses, their experiences with death, and their values and beliefs about that which makes their life worthwhile, then a practitioner can help them with situations which they find difficult to express verbally and which other people may have to do for them. At this moment they see how difficult the situation is and they start an open dialogue regarding decisions concerning the end of life," stated Professor Robinson.

The hypothetical question

This procedure is called "the hypothetical question," a method by which a professional on palliative care can lead the conversation to decision-making on the end of life without having the patient leave their comfort zone. "In order to consider it, she added, it is important for the patient to be informed about the unforeseen situations where their opinions may not be taken into account such as in a heart failure episode or in a tracheal intubation."

In addition, she revealed that "those same patients who hoped to recover chose not to be revived in case of a heart failure or breathing problem, even though their hope was kept intact."

Coinciding with this, she said "families can be prepared so that they can make the most appropriate decisions and help can be given to people so that they can express their wishes without damaging the relationship with the patient or destroying the patient's hopes."