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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
    Seven Guiding Principles

    Principle 2. Communicate the Range of Possible Outcomes Principle 3. Identify Decision Points in Advance

    Principle 2. Communicate the Range of Possible Outcomes

    Avoiding Common Mistakes in Situations of Uncertainty

    • Pitfall #1: Waiting until more is known
      • In situations of prognostic uncertainty, physicians sometimes wait until they have more information before they meet with the patient and family
      • Waiting actually heightens patient and family anxiety
      • It is better to identify what is known early, even if such information is incomplete and there is uncertainty
      • Even if the situation is very uncertain, you, as a physician, know more than the patient or family
      • The sooner family members have information, the sooner they will begin to understand what is happening
    • Pitfall #2: Communicating only extreme outcomes
      • At times physicians choose to provide information in terms of extreme outcomes, rather than discussing the full range of possibilities
      • As excessive optimism is common among physicians and health care workers, sometimes the discussion is limited to only one extreme outcome: the possibility of full recovery
      • In situations of prognostic uncertainty, it is important to communicate the full range of possible outcomes

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    Tips for communicating the full range of possible outcomes

    • Acknowledge uncertainty and discuss it openly
      • Discuss the current situation, the immediate future, and what is likely to
        happen next
      • Convey a range of possibilities, since the actual outcome is often somewhere
        in the middle
    • Be specific about all possible outcomes
      • Use concrete examples to help the family understand
      • Acknowledge the limits of individual case experiences, both yours and the family’s
      • Avoid saying vague things like, "It doesn’t look good" or "I don’t think the outcome will be good"
      • Be more specific by talking about the current information:
        • What you are looking for as positive signs or signs of a worsening condition
        • What outcomes are more likely or less likely
    • Use evidence-based information
      • Where possible, use evidence-based information to support discussions
      • When the situation is particularly difficult consult with colleagues who have a broad experience (e.g., intensivists) and/or knowledge of the relevant, evidence-based literature
    • Check understanding
      • Ask frequently what the patient and family understand in order to check what information they have heard
      • Remember, patients and families may need gentle repetition in order to take it all in (see Module 7: Goals of Care)
    • Involve other health care team members
      • Use other health care team members such as nurses, social workers, and chaplains to help:
        • Support the patient and family
        • Reinforce the information that has been given
      • Spend the time to tell appropriate caregivers the substance of what you have told the patient and family so that mixed messages and confusion are minimized
    • Respond to emotions
      • Anticipate that these discussions will result in strong emotions
      • Be prepared to respond to the emotions that are generated
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