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About

About

This guide is intended to assist medical providers in having conversations with people who have a serious illness. The purpose is to allow effective collaboration with patients and families on creation of a plan of care that is consistent with the patient’s goals and the clinical reality. It can be used as both a checklist and a script for what can be difficult conversations. With experience, medical providers will often develop their own style, while still following the general format of this guide.

Useful Tips

  • Follow the guide while you are learning it
  • Sit down and make eye contact
  • Ask-Tell-Ask (engage patient by asking a question first)
  • Listen
  • Talk less than half the meeting
  • Authenticity – make a connection if possible
  • Allow silence
S: Set-Up

S: Set-Up

  • “I’d like to talk about what we can expect with regard to 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?
  • “So that I am sure to cover everything important, I will be using this guide as we speak.”
P: Perception

P: Perception

  • “What is your understanding of where things stand now with your medical situation?”
I: Information

I: Information

  • “How much information about what you can expect with your illness would you like to know?”
  • “I would like to share with you my understanding about your current medical condition. Would that be okay?”
K: Knowledge

K: Knowledge

  • Life expectancy (Time): “I wish we were not in this situation, but I am worried that your time may be as short as________ (express as a range of days to weeks, weeks to months, months to a year).”
  • Function: “I hope this is not the case, but I worry that you will have ups and downs with this condition, and the trend will be toward losing more and more of your ability to function (i.e. organ system failure).”
  • Uncertainty: “There is a lot of uncertainty here, but I am worried that you will continue to have complications and that things are going to get more difficult for you (or your loved one) over time with this disease (i.e. dementia, frailty).”
E: Emotion/Response

E: Emotion/Response

  • “I can tell this is making you really sad.”
  • “This is really difficult to think about.”
  • “You have fought this cancer so hard.”
  • “No matter what happens, we will do our best to help you get through this.”
  • “Please tell me more about what you are feeling right now.”
G: Goals/Explore

G: Goals/Explore

  • “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?”
O: Options & O: Opinions

O: Options & O: Opinions

  • “I’ve heard you say that ____ is really important to you. Keeping that in mind, and with 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.”
Decisions/Plans

Decisions/Plans

  • “Based on our decisions today, I recommend completion of these documents:
    • South Carolina Physician Order for Scope of Treatment (POST)
    • South Carolina Healthcare Power of Attorney”
Contact Us

Contact Us

If you have questions, please contact advanced care planning at
864-560-3888
News & Highlights

News & Highlights

The Directing Your Life Conversation Guide is also available in a PDF