Aidan: Created page with "{| class="wikitable" !Step !Conversation flow !Patient-tested language |- |1 |Set up the conversation * Introduce purpose * Prepare for future decisions * Ask permission | *..."

2021-02-23T19:56:26Z

Created page with "{| class="wikitable" !Step !Conversation flow !Patient-tested language |- |1 |Set up the conversation * Introduce purpose * Prepare for future decisions * Ask permission | *..."

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{| class="wikitable"
!Step
!Conversation flow
!Patient-tested language
|-
|1
|Set up the conversation

* Introduce purpose
* Prepare for future decisions
* Ask permission
|
* "I'd like to talk about what is ahead with your illness and do some thinking in advance about what is important to you so that I can make sure we provide you with the care you want--'''is this okay?'''"
|-
|2
|Assess understanding and preferences
|
* "What is your '''understanding''' now of where you are with your illness?"
* "How much '''information''' about what is likely to be ahead with your illness would you like from me?"
|-
|
|Share prognosis

* Share prognosis
* Frame as a "wish…worry", "hope…worry”"statement
* Allow silence, explore emotion
|
* "I want to share with you my understanding of where things are with your illness…"
* Uncertain: "It can be difficult to predict what will happen with your illness. I hope you will continue to live well for a long time, but I'm worried that you could get sick quickly, and I think it is important to prepare for that possibility."
* Time: "I wish we were not in this situation, but I am worried that time may be as short as ___ (express a range, such as days to weeks, weeks to months, months to a year)."
* Function: "I hope that this is not the case, but I'm worried that this may be as strong as you will feel, and things are likely to get more difficult."
|-
|4
|Explore key topics

* Goals
* Fears and worries
* Sources of strength
* Critical abilities
* Trade-offs
* Family
|
* "What are your most important goals if your health situation worsens?"
* "What are your biggest fears and worries about the future with your health?"
* "What gives you strength as you think about the future with your illness?"
* "What abilities are so critical to your life that you can't imagine living without them?"
* "If you become sicker, how much are you willing to go through for the possibility of gaining more time?"
* "How much does your family know about your priorities and wishes?"
|-
|5
|Close the conversation

* Summarize
* Make a recommendation
* Check in with the patient
* Affirm commitment
|
* "I've heard you say that ___ is really important to you. Keeping that in mind, and what we know about your illness, I recommend that we ___. This will help us make sure that your treatment plans reflect what's important to you."
* "How does this plan seem to you?"
* "I will do everything I can to help you through this."
|-
|6
|Document your conversation
|
|-
|7
|Communicate with key clinicians
|
|}

== Further Reading ==

* Preparing for Serious Illness: A Model for Better Conversations over the Continuum of Care. ''Am Fam Physician''. 2019;99(5):281-283.

Serious illness conversation guide - Revision history

Aidan: Created page with "{| class="wikitable" !Step !Conversation flow !Patient-tested language |- |1 |Set up the conversation * Introduce purpose * Prepare for future decisions * Ask permission | *..."