Table 7.
Core Tasks, Skills, and Sample Phrases to Improve Clinician-Patient Communication in Advanced Heart Failure
| Steps in the Roadmap | Elements of the Step | Sample Phrases |
|---|---|---|
| Establish the setting and participants | Determine who should be present and ensure that all appropriate clinicians are present as well | “In preparation for our meeting tomorrow, I’m going to have the cardiothoracic surgeon there to be a part of our conversation. In terms of your family or support network, who is it important that we make sure is there?” |
| Determine what patients know and want to know | ASK what patients/families know | “Tell me about your heart disease; how have you been doing lately?” |
| “What is your understanding of what is occurring now and why we are considering the treatment that we have been discussing?” | ||
| ASK what patients/families want to know | “Sometime patients what to know all the details, whereas other times they just want to know a general outline. What kind of person are you?” | |
| “How much information would you like to know about what is happening with your heart disease?” | ||
| TELL the patient/family the information in a sympathetic and thoughtful manner while also clearing up any misconceptions or unanswered questions | “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 review and clarify” | |
| ASK the patient or family to repeat back the information that has been delivered | “Now that I’ve clarified a few things about your illness, I want to make sure you understand what I’ve said. Tell me in your own words what we’ve been talking about” | |
| Establish goals and preferences | Use open-ended questions to gain understanding of the patient’s values to determine what is most important to them | “Help me to understand what is important to you. Some patients say they want to live as long as possible, regardless of quality of life. Sometimes patients tell me they are worried that they will be in a great deal of pain or have other uncontrolled symptoms. What is important to you at this point in terms of your health care?” |
| “What are you hoping for?” | ||
| “What is important to you now?” | ||
| “What is your biggest concern right now?” | ||
| “When you think about the future, what are the things you want to avoid?” | ||
| In cases in which the patient is not involved in the conversation, a useful phrase might be, “What would your loved one say right now if he or she were hearing what we are discussing?” | ||
| Work with patient and family to tailor treatments and decisions to goals | Tailor explanation of benefits/burdens of a particular therapy based on goals established | “I think I understand what is important to you now, and it helps me better explain to you the decisions and treatments at hand now. I’d like to take a moment to review the benefits and burdens of each of the treatments based on what you’ve said is important to you at this point” |
| Be willing to make a recommendation based on the patient’s goals | “Would it be helpful if I made a recommendation based on what you’ve said the overall focus of care should be now?” | |
| “Based on what you have told me, if you get sicker and need to go back on a breathing machine again to stay alive, that is very unlikely to provide the kind of life you want to lead. Therefore, I think you should not go back on those machines” | ||
| Acknowledge that there is uncertainty in the course of heart failure | “One of the most difficult things about heart disease is that we can never know for sure exactly what will happen in the next (hours, days, weeks, etc). We must make our best guess and decide what to do based on that information. If things change, we can always readdress this discussion at any time in the future” |