The team have already identified differing opinions between George’s wife and daughter. His daughter wishes to progress with active treatment but his wife wishes to move towards end of life care.
The acronym ‘PREPARED’ can be used to ensure a consistent approach to dealing with difficult discussions/decisions.
Another helpful system is the REDMAP Framework. See additional information for more information on this and a short video introduction to this framework.
Reference: (adapted) Clayton M, Hancock K, Butow P, Tattersall P, Currow D, 2007 Clinical Practice Guidelines for Communicating Prognosis and End of Life Care Issues with adults in the advanced stages of life limiting illness and their caregivers. Journal of Australian Medical Association, Supplement, 186,12, 77
It is also very important to provide written/visual information to support conversations, understanding and shared decision making. This provides the patient/family with a record of the conversation which they can review and discuss as a family. An example of a shared decision making resource is Tailored Talks, which enables professionals to easily share personalised medical and health information with patients and their families. For more information on how Tailored Talks can support shared decision making in healthcare visit pogodigitalhealth.com
Prepare for the discussion
- Ensure you are up-to-date about the patient’s clinical status and any previous discussions with the patient and family
- Identify who should be present and ensure privacy and minimal interruptions
Relate to the person
- Use effective communication skills such as eye contact, open questioning and active listening
- Make the conversation patient centred and show compassion, empathy and interest
Elicit carer’s understanding or preferences
- Clarify the carer’s understanding of current situation
- Determine how much detail/information the person wants to know
Provide information
- Discuss in a sensitive manner what we are expecting to happen, explaining how time frames can be very difficult to predict
- Pace the amount of information you give and check understanding; you may need to repeat some information
- Ensure all team members provide consistent information over time
Acknowledge emotions and concerns
- Acknowledge patient and families’ emotional reaction to the discussion and respond to any distress
- Explore questions, fears and concerns
(Foster) Realistic hope
- Explain that the focus of care has changed from active treatment to ensuring comfort and alleviating symptoms
- Reassure that support and systems are in place to manage the next steps and that the team are available to provide support
Encourage questions
- Respond to any questions promptly, sensitively and honestly, acknowledging that there may be questions that no-one knows the answers to e.g. How long?, When?
- The patient and their family may have more questions later so leave the door open for further discussion
Document discussion
- It is important to document the discussion clearly in the patient’s case notes
Click for a short video introduction to REDMAP
Page last reviewed: 05 Jan 2021
