The following are some prompts to help healthcarers to have conversations with individuals to clarify and capture what the individual would like for themselves in terms of their future care.  

 

• Start the conversation by finding out from the patient what their level of understanding is of their current condition and prognosis – this helps to establish a common ground.

If the patient doesn’t seem to know, it may be worth summarising for him/her what has happened in the patient’s illness to date and then beginning to talk about the current situation.

 

• Always give the patient the option not to discuss these topics or to defer the discussion to another time.  

Sample Phrase:  “I am very happy to talk to you about any concerns or questions you have about this now or later… Is there anything you would like to ask me about now?”

 

• Do not make assumptions about the information needs of the patient or of his/her family.  

Clarify what the patient wants to know and the level of detail they’d like before giv‐ ing new information.  

Sample Phrase: “Often people with conditions like yours have a lot of questions that are sometimes frightening or sometimes they’re not certain if they want to know the answer. So if there’s anything you’d like to know, feel free to ask me and I’ll answer as best I can.”

 

• Explore the patient’s concerns, expectations and fears about the future.  

Sample Phrase: “What is your biggest concern at the moment?”

 

• Encourage the patient to ask questions and express their wishes.  

Sample Phrases: “Is there anything else you’d like to discuss?” “Have you ever thought about where you would like to be cared for in the future?”

 

• Offer to support the family (as long as the patient has given consent).  

Sample Phrase: “Would you like me to tell…what we’ve discussed?”

 

·  Consider joint as well as separate discussions with the patient and family (once the patient has given consent) so as to explore and address different people’s information needs.   

 

• Once a terminal diagnosis is made, patients can often feel abandoned.

It is important to reassure the patient that you/the team will be there for them throughout their illness.

If this is not possible, it is vital that alternative arrangements are spelled out and are reliable.  

Sample Phrases:  “We will do what we can to manage your symptoms and link you in with the services that will support you and your family. You will not be alone in this.”

 

• Emphasize the available support, such as the palliative care team.  

Sample Phrase: “We have different ways to relieve (pain/nausea/ breathlessness) and other symptoms.”

 

• It is important to enable the patient to feel control over their illness.  

Help the patient to identify where control can be fostered, e.g. tidying up unfinished business, arranging to attend a particular event.

Encourage patients to share in decision making according to their desired level of involvement.  

Sample Phrase: “People vary in how they want to make medical decisions. Some people want to make decisions themselves, some want to share decision making with the doctor. What would you like?”

 

 

 

Acknowledgement: Irish Hospice Foundation.