Challenge: Talking about prognosis

Saturday, November 30, 13

Why don’t we talk about prognosis • Stepping back from the daily tasks • Ambivalence • Bad news • Time Saturday, November 30, 13

Why talk about prognosis • Planning for the future • Prepared • Decreases overtreatment • Family outcome Saturday, November 30, 13

“ADAPT” 1) Ask 2) Discover what info would help 3) Anticipate ambivalence 4) Provide information 5) Track emotion

Saturday, November 30, 13

1. Ask Goals

What to ask

Find out what the patient knows

What have others told you about what may happen in the future

Saturday, November 30, 13

1. Ask Permission •

Key question: “How much do you want to know about the future?”

•

Three kinds of patient responses – Want explicit information – Do not want information – Ambivalent J Clin Oncol 24:4209 and 4214;2006

Saturday, November 30, 13

2. Discover what info would help Goal

Question

Find out about what the concerns/question means

Is there something specific you are worried about?

Ask about the best way to give the information

Some people like to have statistics while others would rather hear about the future in general terms. What is best for you

Saturday, November 30, 13

3. Anticipate ambivalence • 25% patients do not want the information – Acknowledge how hard it is to hear – Explore the reason

• Many more are ambivalent – Attend to how hard this is to discuss

Saturday, November 30, 13

4. Provide the information • Tell your view of prognosis – Uncertainty – “Every person is different. I can only tell you what usually happens to people in your situation, not exactly what will happen to you” – Best, worst and most likely – Small pieces without jargon

Saturday, November 30, 13

5. Track the emotion Goal

How to say it

Attend to the emotional impact of the information

“This is not what you were hoping to hear”

Saturday, November 30, 13

5. Track the emotion • Acknowledge the emotions in the conversation – Name “That was hard to hear” – Understand “I can not imagine what you are doing thru” – Respect “You have done everything we asked” – Support “I will be here for you as we go thru this” – Explore “What are you thinking?” Saturday, November 30, 13

5. Track the emotion • Wish statements – “I wish I could give you better information”

Saturday, November 30, 13

“ADAPT” 1) Ask 2) Discover what info would help 3) Anticipate ambivalence 4) Provide information 5) Track emotion

Saturday, November 30, 13

Conclusion • Effective discussion about prognosis is not giving a pill of information—it’s about – Assessing exactly what patient wants to know – Attending to specific concerns – Attending to emotions

Saturday, November 30, 13

ACS prognosis Miami v 3.1fordist.pdf

4) Provide information. 5) Track emotion. Saturday, November 30, 13. Page 4 of 14. ACS prognosis Miami v 3.1fordist.pdf. ACS prognosis Miami v 3.1fordist.pdf.
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