1. Advance Care Planning
2. Communicating Bad News
3. Whole Patient Assessment
4. Pain Management
5. Assisted Suicide Debate
6. Anxiety, Delirium
7. Goals of Care
8. Sudden Illness
9. Medical Futility
10. Common Symptoms
11. Withholding Treatment
12. Last Hours of Living
13. Cultural Issues
14. Religion, Spirituality
15. Legal Issues
16. Social and Psychological
Clergy and Faith Communities
Step 2. Finding out What the Patient Knows
Step 3. Finding out How Much the Patient Wants to Know
Step 2. Finding Out What the Patient Knows
What to Ask
Start the discussion by establishing what the patient and family know about the patient’s health
With this information, ascertain if the patient and family will be able to comprehend the bad news
- "What do you understand about your (your child’s) illness?"
- "How would you describe your medical situation?"
- "Have you been worried about your illness or symptoms?"
- "What did other doctors tell you about your condition or any procedures that you have had?"
- "When you first had symptom X, what did you think it might be?"
- "What did Doctor X tell you when he sent you here?"
- "Did you think something serious was going on when…?"
When the Patient Seems Unprepared
Occasionally a patient (or a parent if the patient is a child) will fall silent and seem completely unprepared or unable to respond
To ease the situation and stimulate discussion
- Try to clarify what the patient understands about his or her medical history and recent investigations
- Identify absent family members or others on whom the patient relies
Consider rescheduling the meeting for another time...
- If the efforts described above seem ineffective
- If the patient remains silent
- If it appears the patient requires more support