What is the first action you should take for a patient in end-stage renal disease who expresses a wish for their suffering to end?

When addressing a patient's expression of a wish for their suffering to end, it is essential to first conduct a thorough evaluation to understand the underlying reasons for their feelings. Assessing for depression is critical in this situation because it can significantly impact a patient's perception of their condition and overall quality of life. Patients in end-stage renal disease may experience emotional distress, including feelings of hopelessness and despair, which can be influenced by depression.

By evaluating the patient for depression, you can determine if their desire to end suffering stems from a treatable mental health condition. If depression is identified, appropriate interventions can be implemented, which may improve their overall well-being and outlook. This approach prioritizes holistic care, acknowledging that both physical and emotional aspects of suffering must be addressed.

Additionally, while providing comfort care measures is important, this should follow a comprehensive assessment to ensure that all aspects of the patient’s suffering are understood. Simple interventions without proper evaluation may overlook critical mental health needs. Referring the patient to a mental health specialist is beneficial, but only after a thorough assessment is conducted to guide the referral appropriately. Administering a higher dose of opioids may temporarily alleviate physical symptoms but does not address the potential psychological distress that could be profoundly influencing the patient’s experiences.