1. Setting up the Interview
a. Chart review, phone call to referring physician, feedback from RN caring for patient
b. Recognize YOUR AGENDA. What is your goal in setting up this meeting?
c. Setting. Privacy? Are the decisions makers/health care NOKs there? Seats for all?
d. Introduction: Have all introduce themselves. Take their names (writing them ok). Tell them why they are here.
“We are here to discuss the health of __ who is really sick right now. Thank you for coming.”
2. Perception.
a. This is crucial. Before you start… ASSESS how much the patient and family know about the illness. In our experience, they will not listen to you until they are listened to…
b. Before you tell, ask!
c. This is where you can also figure out the patient’s agenda – do your agenda’s align? If not, strategize as you listen about how much can be accomplished today (i.e. if we are breaking bad news we may not be able to discuss hospice care today…)
“What did the doctors tell you about your illness.”
“Tell me more.”
“Did they tell you if you were going to be cured? Is that information you want to know?”
“How has your father seemed to you in these past months?”
3. Invitation to Proceed.
a. You cannot take back a prognosis… and some people just don’t want to know it, life is hard enough.
b. Ask, “Would you like to know if your illness is curable or incurable?” “Do you want me to tell you everything I know or are there some things you don’t want to discuss.”
4. Knowledge
a. Giving the information, making the recommendations.
b. Align and educate, correct misperceptions.
c. Deliver your agenda if appropriate. You are the expert, don’t be afraid to suggest things.
“Mr. C, you are correct in that we were initially able to control the spread of your cancer. I am grateful that you feel stronger and that is a wonderful thing. However, now, the MRI shows us that your cancer has spread. I am so very sorry.”
“Ms. D, given your poor heart, it is time that we focus on assuring you are less short of breath. We will continue to do everything medically helpful for you; but given how sick your heart is, if a time comes and your heart stops beating, I recommend we allow a natural death.”
5. Emotions. Address them. Respond.
“I wish…”
“What is important now, now that you have received this information.”
“If your father were able to be here at this table now, what would he tell us to do?”
“We will do everything helpful for you.”
6. Strategies and Summary. Follow-up and planning next steps. Don’t leave this out!
Bailea WF et al. 2000./Back A et al. 2009.