Serious illness conversations Flashcards
The most reliable way to learn those priorities is
to ask
4 key questions about how SISC came about
- Do they know their prognosis?
- What are their fears about what is to come?
- What are their goals – What would they like to do as time runs short?
- What are the trade-offs they are willing to make? How much suffering are they willing to go through for the possibility of added time?
most patient die in ___ compared to anywehre else
acute care
approx how many people have talked to their health care professional about their health care wishes
13%
how do we define “serious illness”
a condition that:
AND either
or
carries a high risk of mortality
negatively impacts a person’s daily function or quality of life
excessively strains their caregivers
SIC is a _____ lead discussion that
- asks
- shares
- de-emphasizes
- occurs
- provides
- should
- is
Clinician
- patient about values and goals using a structural format
- prognosis, when appropriate
- treatments and procedures
- early in the course of a SI
- a foundation for making a future decision
- be reviewed/revisited overtime
- valuable and therapeutic even if medical decisions are not being made
SIC is not
4
- a convo solely focused on medical decisions
- the most conversation
- a code status convo
- a MAiD discussion
Early conversations about goals of care are associated with
Enhanced goal-concordant care
Time to make informed decisions & fulfill personal goals
Improved quality of life
Higher patient satisfaction
Better patient and family coping
Eased burden of decision-making for families
More and earlier hospice care
Fewer hospitalizations
Improved bereavement outcomes
Follow the principles for the Trauma-Informed Approach (TIP):
(4)
- Trauma Aware
- Emphasis on safety and trustworthiness
- SIC is an opportunity for choice, collaboration and connection with the individual
- Focus on individual strengths and skills
Set up the conversation
- Builds
- introduce
- ask
- trust
- purpose and prepare for future decisions
- permission
one of the most important goals before starting the discussion
reduce anxiety for both the clinician and patient
3 main ways to share prognosis
- uncertain
- time-based
- function
you can also explore previously disclosed prognosis information
3w’s communication tips
i wish
i worry
i wonder
respond to emotion by
naming it and exploring it
strategies to help with emotions in convos
N-aming
U-nderstanding
R-especting
S-upporting
E-xploring
When closing the conversation, clinicians should have two goals in mind.
- help patients feel heard and understood
- make recommendations based on patients’ values and goals shared in the convo.
serious illness recommendation aid
Wellbeing
illness
support system
help
The purpose of prognostication is
To help patients begin a planning process ‘just in case,’ not to be right or wrong
Prognostic information can reduce
anxiety & depression (knowledge is power)
