First Do No Harm: Communication Surrounding Non-Beneficial Treatments.

Despite a consensus in the medical community that clinicians should not offer non-beneficial treatments (NBTs) to their patients, little guidance exists on the particular communication needs around this fraught topic. While intended in the spirit of non-maleficence, setting limits around NBTs can be seen by patients and families as abandonment, resulting in conflict.In this paper, we propose a framework to guide Palliative Care clinicians in communicating about these complex issues with patients and families. We offer 2 cases illustrating requests for treatments deemed non-beneficial, along with language to aid clinicians in navigating similar instances in their own clinical practice. Our framework emphasizes proactive relationship building with patients and families, close attention to their values, and compassionate limit-setting when medically appropriate. We propose approaching these discussions with a "breaking bad news" framework rather than one of shared decision-making. By carefully attending to their communication in these matters, clinicians can build trust with patients and families and avoid burdening them with false choices. This will ultimately minimize conflict, allay fears of abandonment and result in higher quality care for seriously ill patients.