October 2015 HFH Physician Newsletter Article
More on Caring Conversations…
‘You can’t tell me how long I have to live, only God knows what will happen to me.”
When faced with a patient or surrogate decision-maker who is avoiding a discussion of prognosis, we are often left wondering, “How can we discuss reasonable treatment plan options if they won’t acknowledge that their condition is terminal?” At times, we spend hours trying to convince them of their prognosis and other times we throw our hands up in frustration, capitulate to their demands or avoid future discussion altogether. None of these reactions accomplish what we physicians want: to provide our patients with the best medical care.
How can we do better?
We have to recognize that this is a challenging topic for patients as well as providers. Then we can acknowledge the effectiveness of our own communication skills. The next time you find yourself considering a prognosis discussion, take a pause and consider a patient-centered approach: ADAPT.
Ask what they already know
Discover what information about the future would be useful for them
Provide information in the form the patient/surrogate wants
Track & respond to emotion
Using this roadmap will improve your chances of successfully navigating prognosis discussions and minimize feelings of defeat and burn-out. Read examples of each tool used in the example conversations below.
We have a responsibility to guide our patients and their surrogates through their illness. We can acknowledge the uncertainty of prognosis and that at times our patients/surrogates will not be comfortable discussing prognosis. This understandable discomfort need not be the end of our value as physicians; it can be the beginning of a new conversation.
For more reading on published evidence about discussing prognosis: Back, Anthony L.; Arnold, Robert M., “Discussing Prognosis: ‘How Much Do You Want to Know?’ Talking to Patients Who Do Not Want Information or Who Are Ambivalent”; The Art of Oncology 2006, v24(25): 4214-4217, or Smith, Alexander K et al, “Uncertainty: The Other Side of Prognosis”; NEJM 2013. v368(26): 2448-2450.
This is one of many skills that can be practiced with the Caring 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.
Caring 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 Caring Conversations team members are: Rana Awdish, M.D.; Dana Buick, M.D.; Kristen Chasteen, M.D.; Erin Zimny, M.D.; Maria Kokas, Ph.D.