Clinical Practice Supports image

Conversations about Serious Illness

Purpose

The following guide will provide supporting educational materials for health care providers on how to initiate conversations about serious illness with patients and their family members.

The main areas of focus are outlined below:

  • Think, Learn, Choose, Talk, Record (5 steps)
  • Personal Directive
  • Choosing a substitute decision-maker/delegate
  • "What if something happens?"
  • Discussions within context of illness
  • Understanding prognosis, goals, fears, values, "trade-offs", what is important
  • "What if this happens?"
  • Specific, in the moment
  • Guided by the above
  • "This is happening"

Goal of Conversations about Serious Illness

The goal of initiating conversations about serious illness is to identify a plan of care that reflects the goals, values, and wishes of the patient.

Educational content in this guide is focused on enhancing health care providers' abilities to lead Advance Care Planning (ACP) and Goals of Care (GOC) conversations, as well as encouraging the standardized use of the Conversations About Serious Illness tools and resources.

When to Have a Conversation about Serious Illness

Common situations may trigger a health care provider to begin a serious illness conversation with a patient, including:

  • Determining that your patient’s remaining life expectancy is less than 1 year
  • Noticing a recent functional decline in your patient
  • Being aware that your patient is receiving third-line chemotherapy

First, the health care provider should establish clear permission with the patient to begin a serious illness conversation. Once permission is obtained, work with the patient to determine type and volume of information needed.

Bernacki R & Block S. Communication about serious illness care goals: a review and synthesis of best practice. JAMA Intern Med.2014; 174(12):1994-2003.
Brighton L & Bristowe K. Communication in palliative care: talking about the end of life, before the end of life. Postgrad Med J. 2016;92:466-470.
Clayton J, Hancock K, Parker S, Butow P, Walder S, Carrick S et al. Sustaining hope when communicating with terminally ill patients and their families: a systematic review. Psycho-Onc. 2008;17:641-659.
Johnson S, Butow P, Kerridge I, Tattersall M. Advance care planning for cancer patients: a systematic review of perceptions and experiences of patients, families and healthcare providers. Psycho-Onc. 2016;25:362-386.
Larkin J, Block S, Billings A, Koritsanszky L, Cunningham R, Wichmann L et al. Improving communication about serious illness in primary care: a review. JAMA Intern Med. 2016;176(9):1380-1387.

Benefits

What are the benefits of ACP and GOC discussions for health care providers?

  • Reduces moral distress
  • Reduces conflict
  • Avoids unnecessary treatment
  • Promotes discussion about various options for care
  • Promotes/increases awareness and understanding of resources and support, before a crisis
  • Promotes a shared understanding within the care team

What are the benefits of ACP and GOC discussions for patients and families?

Patients who have end-of-life conversations with their doctors and family members...

  • Are more likely to be satisfied with their care
  • Will require fewer aggressive interventions at the end of life
  • Place less of a strain on caregivers
  • Are more likely to take advantage of hospice resources or die at home