Table 4.

Transitional Summary

Patient: All these doctors keep asking me questions, and I don't know what to do. How can they expect me to make such big decisions? It's all so complicated.

Clinician:(reflection) These decisions feel pretty overwhelming to you. Let's take it one piece at a time to make it a bit easier. What have the doctors told you about the cancer?

Patient: They say any more chemo would just kill me. That chemo was just terrible anyway, plus I've had all this pain. I can't stand the pain anymore.

Clinician: (reflection): Getting the pain in better control is pretty important. What else is important to you these days?

Patient: Well, I want to see my grandkids and spend time at home instead of in the hospital all the time. But I don't want to just go home and die either.

Clinician: (reflection): You don't like to be at the hospital, but you're afraid that going home means that you're giving up.

Patient: Yeah, they just keep talking about hospice. I don't want to just give up. I know there's no chemotherapy but if I get something where there's a chance that I'll get better, sure I would do it.

Clinician (summary): So, just to make sure I've got this right, you've heard from the oncologists that they have no more chemotherapy to offer. You've been through a lot of pain, and an important priority for you at this time is to have your pain controlled. You also want to spend time with your family. However, staying alive as long as possible is also important as long as you don't have to spend all of your remaining time in the hospital. Do I have that right?

Patient: Yes, that's about right.