More on Caring Conversations…
The next time you find yourself at a crossroads with a patient where the “old” treatment is not working, and the next step may have harms that outweigh benefits, consider this framework for communicating with your patients.
“We’re in a different place,” or “we are at a crossroads,” can serve as a warning shot for the specific news about the treatment failure. Serious news naturally leads to an emotional reaction. We can help our patients by expressing empathy. One option is to name the emotions. Examples are:
· “Hearing news like this can be shocking.”
· “This is very sad news.
Patients may strongly dislike it when a physician begins by summarizing the list of treatments that we have attempted. It is often our instinct to begin a serious news discussion by reminding them (and ourselves) of our value. This approach may be perceived as defensive and can alienate our patients. It can be helpful, and sometimes necessary, for patients or surrogates to hear in plain language that we are embarking on a new phase of their illness before they are able to engage in the discussion of next steps.
Even in the absence of a “next treatment” to offer, our patients rely on our expertise to guide them. Most patients want our recommendations to be concrete and specific, followed by time for consideration before decisions are required. Most need to hear statements like:
· “This can be very hard to talk about.”
· “When you feel ready, let’s talk about what we can do now.”
· ”I can help guide you through the next steps.”
We have a responsibility to help our patients understand where they are in their disease process, empathize when the news is serious and guide them through the decisions that follow. We have the knowledge and can improve our communication skills to help them find “a new place to land,” after a prior treatment regimen is no longer beneficial.
The end of a treatment modality need not be the end of our value as physicians; it can be the beginning of a new conversation. After you try this approach, please send an email and let us know how it went.
This is one of many skills that can be practiced with the Caring Conversations Communication 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.; Michael Mendez, M.D.; Maria Kokas, Ph.D.; and Cari Williamson, BA.