Serious Illness Conversation Guide - Clinical Nutrition
SET UP the conversation
I’d like to talk together about what’s happening with your nutrition and what matters to you. Would this be okay?
ASSESS patient understanding
To make sure I share information that’s helpful to you, can you tell me your understanding of what’s going on with your nutrition now?
How much information about what might be ahead with your nutrition would be helpful?
SHARE PROGNOSIS/ANTICIPATORY ADVICE
I want to share my understanding of where things are with your nutrition [Choose one]:
Uncertain: It can be difficult to predict what will happen. I hope you will be able to [eat normally again, regain weight, tolerate TPN or tube feeding] for a long time, and we will work toward that goal. It’s also possible that you could get sick quickly, and I think it’s important that we prepare for that.
OR
Function: It can be difficult to predict what will happen. I hope you will be able to nourish yourself for a long time, and we will work toward that goal. It’s also possible that it may get harder get the nutrition you need [if applicable to tolerate medical treatment] because of your illness, and I think it’s important that we prepare for that.
Pause: Allow silence. Validate and explore emotions.
EXPLORE goals & values
1. If your health gets worse, what are your most important goals?
2. What are your biggest worries about the future with your [eating/drinking/TF/TPN/nutrition]?
3. What nutrition-related activities bring joy and meaning to your life that you can't imagine living without?
4. If you were unable to eat by mouth, would you want to be fed through a nasal tube or IV line if your doctors felt it was appropriate?
5. How much do the people closest to you know about your priorites and wishes for your eating and nutrition?
6. Having talked about all of this, what are your hopes for your nutrition?
CLOSE with a recommendation
I've heard you say _____. Keeping that in mind, and what we know about your health and current nutrition, I recommend that we _____. I will also pass this information to the rest of your healthcare team. This will help us make sure that your nutrition plan reflects what's important to you. How does this plan seem to you?
We will do everything we can to help you through this.
Click here for instructions on documenting your conversation in Epic.