| 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
|
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