Transitions/Goals of Care

We designed this talking map to give you a just-in-time route through a complex conversation. Think of it as a series of signposts—you might find that not all apply to a particular patient.

Step	What you say or do
1. Reframe why the status quo isn’t working.	You may need to discuss serious news (eg a scan result) first. “Given this news, it seems like a good time to talk about what to do now.” “We’re in a different place.”
2. Expect emotion & empathize.	“It’s hard to deal with all this.” “I can see you are really concerned about [x].” “Tell me more about that—what are you worried about?” “Is it ok for us to talk about what this means?”
3. Map the future.	“Given this situation, what’s most important for you?” “When you think about the future, are there things you want to do?” “As you think towards the future, what concerns you?”
4. Align with the patient’s values.	As I listen to you, it sounds the most important things are [x,y,z].
5. Plan medical treatments that match patient values.	Here’s what I can do now that will help you do those important things. What do you think about it?
EXTRA: Expect questions about more anticancer treatment.	Here are the pros and cons of what you are asking about. Overall, my experience tells me that more chemo would do more harm than good at this point. It’s hard to say that though.
EXTRA: Talk about services that would help before introducing hospice	We’ve talked about wanting to conserve your energy for important things. One thing that can help us is having a nurse come to your house to can help us adjust your medicines so you don’t have to come in to clinic so often. The best way I have to do that is to call hospice, because they can provide this service for us, and more.
	Copyright VitalTalk 2019