Serious Illness Conversation Guide
SET UP the conversation
I’d like to talk together about what’s happening with your health 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 health now?
How much information about what might be ahead with your health would be helpful?
SHARE PROGNOSIS/ANTICIPATORY ADVICE
I want to share my understanding of where things are with your health [Choose one]:
Uncertain: It can be difficult to predict what will happen. I hope you will feel as well as you can 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
Time: I wish this was not the case. I am worried that time may be as short as ____ (express as a range, e.g. days to weeks, weeks to months, months to a year).
OR
Function: It can be difficult to predict what will happen. I hope you will feel as well as you can for a long time, and we will work toward that goal. It’s also possible that it may get harder to do things 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?
3. What gives you strength as you think about the future?
4. What activities bring joy and meaning to your life that you can't imagine living without?
5. If your health gets worse, how much would you be willing to go through for the possibility of more time?
6. How much do the people closest to you know about your priorites and wishes for your care?
7. Having talked about all of this, what are your hopes for your health?
CLOSE with a recommendation
I've heard you say _____. Keeping that in mind, and what we know about your health, I recommend that we _____. This will help us make sure that your care 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.