We designed this talking map to give you a just-in-time route through a complex conversation. Think of it as a series of signposts—you might find that not all apply to a particular patient.
Step 1. Reframe why the status quo isn’t working.
What you say or do:
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You may need to discuss serious news (eg a scan result) first. “Given this news, it seems like a good time to talk about what to do now.”
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“We’re in a different place.”
Step 2. Expect emotion & empathize.
What you say or do:
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“It’s hard to deal with all this.”
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“I can see you are really concerned about [x].”
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“Tell me more about that—what are you worried about?” “Is it ok for us to talk about what this means?”
Step 3. Map the future.
What you say or do:
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“Given this situation, what’s most important for you?”
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“When you think about the future, are there things you want to do?”
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“As you think towards the future, what concerns you?”
Step 4. Align with the patient’s values.
What you say or do:
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As I listen to you, it sounds the most important things are [x,y,z].
Step 5. Plan medical treatments that match patient values.
What you say or do:
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Here’s what I can do now that will help you do those important things. What do you think about it?
EXTRA: Expect questions about more anticancer treatment.
What you say or do:
- Here are the pros and cons of what you are asking about. Overall, my experience tells me that more chemo would do more harm than good at this point.
- It’s hard to say that though.
EXTRA: Talk about services that would help before introducing hospice
What you say or do:
- We’ve talked about wanting to conserve your energy for important things. One thing that can help us is having a nurse come to your house to can help us adjust your medicines so you don’t have to come in to clinic so often.
- The best way I have to do that is to call hospice, because they can provide this service for us, and more.