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Modules:

  • Introduction
  • 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

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    Back to Module 8: Sudden Illness
    Responding to Situations of Sudden Illness

    Guiding Principles - An Overview
    Seven Guiding Principles

    Guiding Principles - An Overview

    An understanding of the characteristics common to stressful situations involving sudden illness will help the physician to guide care more effectively. Although each situation will differ, we propose 7 guiding principles to help with decision-making during intense situations. We have outlined these principles in this overview. Following the overview, we provide a detailed discussion of each of the 7 principles.

    Principle 1. Provide Structured Interaction

    • Establish regularly scheduled communications between:
      • One person from the family and

      • One person from the health care team
    • This practice:
      • Reduces confusion

      • Avoids misunderstandings

      • Helps to keep things on track


        • Get the setting right
        • Ask the family what they understand before giving them information
        • Respond to their emotions (and anticipate that emotions will be prominent and fragile)
        • Establish a follow-up plan, even if it’s just for the next few hours

    Principle 2. Communicate the Range of Possible Outcomes

    • In situations of prognostic uncertainty, do not wait to communicate, even if there is little known information
    • Tell what you do know as soon as possible
    • Provide the relevant information to help the patient (or parents if the patient is a child) and family make informed choices
    • Discuss all possible outcomes
    • Be as clear and direct as possible

    Principle 3. Identify Decision Points in Advance

    • Identify the points in the future when additional information will be available that will help with decision-making
    • Be clear about when you think decisions will be needed
    • It is important to begin to prepare the family early in the process

    Principle 4. Use the General Goals of Care to Guide Decision-Making

    • Discussion of goals of care should be ongoing
    • Decisions about treatment priorities should be based on the patient’s goals and beliefs
    • It cannot be stressed enough how important this step is

    Principle 5. Take Sociocultural Differences Into Account

    • If necessary, try to involve a colleague to help transcend sociocultural differences that may impede supportive decisions
    • Explain concepts in clear language that is easy to understand
        For Example
        Use words like "worse" rather than "progressing"
    • Check understanding regularly

    Principle 6. Manage Symptoms Effectively

    • Sudden illness, particularly trauma, is accompanied by multiple symptoms and suffering
    • Always ensure that all symptoms are managed effectively, throughout the course of the illness

    Principle 7. Consider the Impact of Stress on Caregivers

    • The chaos and occupational stress of situations involving sudden illness can have considerable impact on caregivers
    • They experience a range of emotions during any given case of sudden illness
    • As cases accumulate, so may the stressors
    • These may be manifested in a caregiver’s personal and professional life and may affect clinical decision-making

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    Seven Guiding Principles

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