March 2016 HFH Physician Newsletter Article
More on CLEAR Conversations…
“What do you want us to do for you if you are too sick to make decisions for yourself?”
When our patients become seriously ill and are not able to make their own decisions, we rely on surrogate decision makers. However, many of our patients have not completed advanced directives. We are often left wondering, “Would there be less emotional conflict in making a medical plan if the patient had been clear about their wishes?” Relying on a surrogate decision-maker who has not received clear instructions can be overwhelming to loved ones and the medical team, alike.
How can we do better?
We have to recognize that this is a challenging topic for patients as well as providers. By improving the effectiveness of our own communication skills, we can improve the experience and care of our patients. The next time you find yourself in an “average office visit,” take a moment to consider a patient-centered approach for discussing advance directives: PAUSE.
Using this roadmap will improve your chances of successfully navigating advance-directives conversations as well as the success of future medical care plans. Think of it as a series of signposts—you might find that not all apply to a particular patient.
We have a responsibility to guide our patients through their health and their illnesses. We can acknowledge the importance of planning for unfortunate times and the emotional challenge inherent in end-of-life discussions. This understandable discomfort need not diminish our value as physicians; a clear roadmap can be the beginning of a new conversation.
For more reading on published evidence about discussing prognosis: Tulsky, JA, “Beyond Advance Directives: importance of communication skills at the end of life.”; JAMA 2005, v294(3): 359-65.
This is one of many skills that can be practiced with the CLEAR Conversations Program. Established by a group of Henry Ford physicians in 2012, the goal of the program is to improve conversations between providers and patients.
CLEAR Conversations has roots in the VitalTalk format and accordingly, utilizes highly skilled improvisational actors to create an ideal environment for experiential learning.
Henry Ford Health System CLEAR Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Erin Zimny, M.D.; Maria Kokas, Ph.D.; Hannah Beels, Michelle Turylo.