Clinical practice guidelines - Communicating prognosis and end-of-life issues (Summary)
The clinical practice guidelines are summarised using the acronym PREPARED
Prepare for the discussion, where possible:
Relate to the person:
- Confirm pathological diagnosis and investigation results before initiating discussion
- Try to ensure privacy and uninterrupted time for discussion
- Negotiate who should be present during the discussion
Elicit patient and caregiver preferences:
- Develop rapport
- Show empathy, care and compassion during the entire consultation
Provide information, tailored to the individual needs of both patients and their families:
- Identify the reason for this consultation and elicit the patient’s expectations
- Clarify the patient’s or caregiver’s understanding of their situation, and establish how much detail and what they want to know
- Consider cultural and contextual factors influencing information preferences
Acknowledge emotions and concerns:
- Offer to discuss what to expect, in a sensitive manner, giving the patient the option not to discuss it
- Pace information to the patient’s information preferences, understanding and circumstances
- Use clear, jargon-free, understandable language
- Explain the uncertainty, limitations and unreliability of prognostic and end-of-life information
- Avoid being too exact with timeframes unless in the last few days
- Consider the caregiver’s distinct information needs, which may require a separate meeting with the caregiver (provided the patient, if mentally competent, gives consent)
- Try to ensure consistency of information and approach provided to different family members and the patient and from different clinical team members
(Foster) Realistic hope:
- Explore and acknowledge the patient’s and caregiver’s fears and concerns and their emotional reaction to the discussion
- Respond to the patient’s or caregiver’s distress regarding the discussion, where applicable
Encourage questions and further discussions:
- Be honest without being blunt or giving more detailed information than desired by the patient
- Do not give misleading or false information to try to positively influence a patient’s hope
- Reassure that support, treatments and resources are available to control pain and other symptoms, but avoid premature reassurance
- Explore and facilitate realistic goals and wishes, and ways of coping on a day-to-day basis, where appropriate
- Encourage questions and information clarification; be prepared to repeat explanations
- Check understanding of what has been discussed and if the information provided meets the patient’s and caregiver’s needs
- Leave the door open for topics to be discussed again in the future
- Write a summary of what has been discussed in the medical record
- Speak or write to other key health care providers involved in the patient’s care. As a minimum, this should include the patient’s general practitioner
Ref: Clayton JM, Hancock KM, Butlow PN, Tattersall MHN, Currow DC. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust. 2007;186(12):77.
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