Observe the clinician demonstrating the conversation. Note the patient's emotions during the conversation. Emotions can come up anytime during the conversations. Emotions can be varied including tears, anger and refusal to
talk.
Assess patient understanding and information preferences
Share prognosis/concerns
Share illness understanding
Frame as a "wish...worry", "hope...worry" statement
Explore key topics
Goals
Fears and worries
Sources of strength
Critical abilities
Trade-offs: Willing to go through...
Family awareness
Summarize and recommend/plan
How can I respond when a patient is upset?
Allow silence. Name the emotion and take time to explore it. Some examples could be:
You seem really upset. Tell me more about what you are feeling.
You seem surprised. Tell me about what you were expecting to hear.
This is really hard to hear. Tell me what you're thinking about.
Quick tips
The questions and order of the serious illness conversation is based on research. It is ideal to complete the questions in order, but in some situations, you may need to adjust it based on your clinical judgement.
The topics and wording in the conversation guide may not feel natural at first. However, with practice and time, you will get more comfortable. After a while, you may come up with wording that feels more natural, but please ensure that you keep to the intent of the original questions.
Reverting to what you are comfortable talking about is natural.
The first priority is learning about the patient's values and goals.
You may feel tempted to offer recommendations and interventions as soon as the patient identifies a specific need. To ensure that the patient feels heard and to get a more complete picture of the patient's values and wishes, you should first ask about as many key topics as possible and save recommendations for "Step 5: Summarize and Recommend". One way to do this is to reassure the patient that you will return to the issue in question towards the end, but that you'd like to learn more about their perspective first.
