SISTM guide to Patient Conversations
Set the Stage
Choose words carefully
Invite relevant people
Allow adequate time
Be mindful
EXAMPLES:
"I'd like to talk about where we are with your care and make plans for the future."
"Would you like your wife to be here with you?"
Other Tips:
Ask staff to hold calls and avoid interruptions. If you do not have time to review everything with the patient in one meeting, ask to schedule another appointment.
Close the door or pull the curtain around the bed. Let the patient dress after an examination before starting the conversation. Silence all electronics.
Sit at eye level beside the patient and make eye contact. Maintain a calm posture, avoiding nervous movements.
Adjust you approach as needed and have a translator present if there are language barriers.
Inquire with curiosity
What is the patient's understanding of their condition?
Do they want you to share all that you know?
What are their end of life goals?
EXAMPLES:
"Tell me what you've been told about your illness. How are you feeling about where you are with your illness?"
"How much information do you want me to give you about your illness? Do you want all of the details?"
"What do you hope to achieve with the current treatment, and what do you see for yourself in the future?" You might also reflect on a recent setback or hospitalization and how it was difficult for the patient.
Other Tips:
If there is outright denial, don't press the issue. "That's fine if you don't want to talk about this right now. Maybe we can discuss it later if your situation changes?"
Speak Directly
Lead with a sensitive warning
Be honest about prognosis, probability of cure/improvement
Speak slowly, clearly, and with expression
Mirror patient's language, avoid jargon
Ask for questions and ask patient to repeat what they heard.
EXAMPLES:
"I'm so sorry to tell you...."
"I wish that I had better news for you, but unfortunately..."
Other Tips:
Talk openly to the patient about what will happen. Some fears can be assuaged with straightforward information.
"Do you have any questions? Is there anything you need me to explain further?"
Take the time
Allow for quiet time so patient can process, expect emotions
Ask open-ended questions like, “How are you feeling about this information?”
Validate upset feelings. “I feel worried about disappointed too.”
Help loved ones redirect hope award from finding a cure and toward finding comfort for the patient.
EXAMPLES:
“The results of the tests are very worrisome. I can see why you would be so upset.”
“There is still hope with comfort-only care. We can hope for better pain control and to maximize your quality of life from day to day.
Other Tips:
It’s okay to have some silent moments during the discussion.
Resist the urge to fill silences with more information.
Asking “How do you feel about the test result” is better than “Are you disappointed with the test results?”
Make a Care Plan
Initiate the next step. “I would like to have a nurse from our Comfort Care team give you some information about non-curative options.” – Refer to Beloit Regional Hospice
Reassure patient that they make the decision.
Reassure patient that you will remain very involved.
If patient is ready, develop a care plan that integrates hospice services.
Review the plan.
Schedule follow-up if patient wants more time.
EXAMPLES:
Clarify everyone’s role in the care plan. Reassure the patient that you will either be there every step of the way, or will be available if the patient needs to reach you.
Ask the patient if there are any other questions and schedule another meeting if you need more time to review.