Blog | Thursday, May 8, 2014

QD: News Every Day--Meet patient's hope for a miracle recovery with an 'AMEN'

Researchers presented a new method, AMEN (affirm, meet, educate, no matter what), as a tool for physicians to negotiate with patients and families in desperate situations who are hoping for a miraculous yet medically unlikely recovery.

Corresponding author Thomas J. Smith, MD, FACP, and colleagues wrote that 57% of randomly surveyed adults said that God’s intervention could save a family member involved in trauma even if physicians had declared that treatment would be futile, while another study noted that nearly three-quarters of respondents said that patients have a right to demand such treatment. The authors cited a third study that stated that 1 in 5 clinicians believe that God could reverse a hopeless outcome.

Clinicians may meet a patient’s and family’s hope for a miracle by redirecting the conversation back to medical expectations, the study noted. “What ensues is often awkwardness, a rote repetition of the medical information without acknowledging the religious or spiritual implications of the response, or perhaps even defensiveness.” This may leave the patient feeling unheard, anxious, or disconnected from a provider.

Clinicians may unintentionally place themselves in direct competition with religious beliefs when the provider verbally responds to the patient’s or family’s hope for a miracle with the word “but,” the authors wrote. “For a religious patient, not even an esteemed or beloved physician will win in a contest with God.”

The AMEN methodology was published online May 6 at the Journal of Clinical Oncology Practice.

AMEN is similar in spirit to another communication system, VALUE (value, acknowledge, listen, understand, elicit), and is designed to do 4 things:
1. Affirm the patient’s belief and validate his or her position: for example, by saying, “I am hopeful, too.”
2. Meet the patient or family member where they are: for example, “I join you in hoping (or praying) for a miracle.”
3. Educate as a medical provider: for example, “And I want to speak to you about some medical issues.”
4. No matter what, assure the patient and family of commitment to treatment: for example, “No matter what happens, I will be with you every step of the way.”

“We further maintain that the most appropriate frame for the miracle conversation is in the context of hope rather than religious belief,” the authors noted. “With the use of the AMEN protocol, we expect that the provider’s connection will be maintained or strengthened with the patient or family member who hopes for a miracle in the face of poor medical odds. AMEN gives the provider the opportunity to join the patient and family at their comfort level conversationally and enter the portal offered by the patient or family member to continue the dialogue.”