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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
How to Get the Conversation Started

How to Get the Conversation Started

  • I’d like to talk about what may be 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 – would that be okay?
  • So that I am sure to cover everything important, I will be using this guide as we speak.

Assess patient’s perception of current illness

  • Please tell me, what is your understanding of where things stand now with your medical situation?

Assess preferences for information

  • "Are you the kind of person who likes to know the full truth about your medical condition?
  • How much information about what may be ahead with your illness would you like me to share with you?
Share Your Knowledge of the Patient’s Current Clinical Reality and Prognosis

Share Your Knowledge of the Patient’s Current Clinical Reality and Prognosis

  • Medical information – The relevant “medical story” up to this point, from the medical provider’s standpoint.
  • Prognosis (very carefully) – “May I share with you what I think the future may hold for you with this illness?

Use any of these

  • Life expectancy – “I am worried that your time may be as short as _____  (express in a range such as days to weeks, weeks to months, or months to a year).
  • Function – “I hope that this is not the case, but I am worried that this may be as strong as you will feel and that things are going to get more difficult over time.
  • 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 am worried you may get sick very quickly. It is important to prepare for that.

Emotion

Be sure to allow time for the patient or family to express emotion, which may include sadness, fear, anger or other emotions. Sometimes just being present with the patient in silence, as difficult as that is, is the best thing to do to allow emotion to run its course, as it generally will.

Explore Goals of Care

Explore Goals of Care

  • If we agree about where things stand with your illness, I hope we can talk about your medical care from here on out. Is that okay?
  • What are your most important goals if your health situation worsens?

Other useful questions

  • Fears/worries – “What are your fears and worries about the future with your health?
  • Function – “What abilities are necessary for you to have an acceptable level of function?
  • Trade-offs – “If you become sicker, how much are you willing to go through for the possibility of gaining more time?
  • Family – “How much does your family know about your priorities and wishes?
Make a Plan, If Possible, and Close the Conversation

Make a Plan, If Possible, and Close the Conversation

  • 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 plan to do this_____. This will help make sure that your treatment plans reflect what is most important to you.
  • How does that sound?
  • I will do everything I can to help you through this.
After the Conversation

After the Conversation

  • Assist/direct patient or support staff in completion of documents:
    • South Carolina Health Care Power of Attorney – Patient may complete on their own, or staff may provide support.
    • Transport DNR form
    • DYL Advance Medical Care Plan – Epic template for patients with serious illness completed by the medical provider or designee.
  • Document in the Epic template
  • Communicate with key clinicians if necessary about the newly formulated plan of care
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