Differences in opinion and approach to conflict resolution in palliative care

Good communication is key to both preventing and resolving conflict about care at the end of life. There may be fundamental differences in beliefs between a patient (or their substitute decision-maker) and their family, carers and healthcare professionals. While an individual ultimately makes the decision, it is preferable to seek consensus during the decision-making process, if possible. Try to agree on core values and what constitutes good and compassionate care at the end of life (eg establishing relief of suffering, maintenance of dignity).

When there are differences in opinion it may be helpful to hold a family meeting and use a generic approach to conflict resolution, as follows:

• clarify the issues without prejudice or any attempt to solve the problem(s)
• identify people’s different positions and then attempt to lay them aside
• identify the patient’s interests and try to get agreement about them
• explore solutions that further these interests
• adopt workable solution(s) through a process of consensus.

A second opinion from an independent or expert source may occasionally be needed before action is taken in a conflict situation. If the patient is an inpatient, hospitals may have a patient advocate or risk manager to assist in conflict resolution. If further advice is needed, Australian states and territories have public officers or bodies, such as a public advocate or guardianship board.