Table 2.
Techniques to Improve Communication with MCS Patients and their Caregivers. Examples provided focus on time of device implantation, but the steps apply to any conversation about prognosis or therapeutic options. Adapted from references.41-43 Portions adapted with permission from Wiegand DL, Kalowes PG. Withdrawal of cardiac medications and devices. AACNAdv Crit Care. 2007;18:415-425. Portions also adapted from Arch Intern Med. 2008;168:1733-1739, Copyright © 2008. American Medical Association. All rights reserved.
| Communication Step | Sample Phrases to Begin each Step |
|---|---|
| 1. Determine what patient/caregiver know about the illness | “Tell me what you understand about your heart disease - how have things been going of late? What have the other doctors told you about what to expect and your treatment options?” |
| 2. Specifically ask what patient / caregiver know about MCS | “Tell me what you understand about Mechanical Circulatory Support systems. What is its purpose?” |
| 3. Determine what patient / caregiver wants to know about illness | “Some of my patients like to know many details, and others prefer a more general outline. What kind of person are you? How much information do you want about your disease and the role of MCS in treating it?” |
| 4. Clarify misconceptions about illness or treatment options | “I think you have a pretty good understanding of what is happening with your heart, but there are a few points I'd like to clear up.” |
| 5. Determine overall goals of care | “Help me to understand what is important to you in terms of your overall care. Some patients tell me that the most important goal is to be able to continue interacting with friends and family in a meaningful way. Others tell me they want to live as long as possible, regardless of quality of life. Some patients are very worried that they will be in pain or have other uncontrolled symptoms. Do you have any concerns like the ones I've mentioned?” |
| 6. Tailor treatments to goals | “Given what you've told me, I think consideration of MCS does/does not make sense for you.”* |
| 7. Ask patient/caregiver to summarize conversation to assure understanding | “We've covered a lot of information. Please tell me in your own words what you understand the plan to be. We can then discuss any questions you might have.” |
| 8. Make plan for next steps. | “I will speak with the other members of the MCS team to make sure we are all in agreement about MCS and that they are aware of your goals of care. Members of the team will come to talk with you about this again.” |
Phrase chosen here depends on whether use of MCS is in line with the patient's goals of care. If a patient stated that they did not want any further procedures or life-sustaining treatments, then one would proceed with the language explaining that MCS is not in line with the patient's stated goals.