Table 4.

An ASK-TELL-ASK example for giving information to a family member of a patient with severe stroke.

ASK (Stroke Neurologist): Before giving information, the provider explores what the patient or family understand about the illness and treatment and assesses their desire for information. This approach encourages an active dialogue, allows the patient/family to shape the direction of the conversation and helps the provider adjust their information to the individual setting, for example:

“What have the doctors told you about what is going on with your loved one and what your loved one's prognosis and treatment options are?”

TELL (Stroke Neurologist): After eliciting the patient/family's understanding, the provider frames the information in a way the patient/family understand. Giving a ‘warning shot’ (“I have difficult news for you”), allows the patient/family to prepare emotionally, for example:

“I'm concerned as well. I would like to tell you a little more about what I see is likely to happen down the road, and then I would like to review with you some things that we can do (pause to allow family to absorb information.) First, I am worried that she will get worse...”

ASK (Stroke Neurologist): The second Ask gives the provider the opportunity to explore how well their information was understood and which points may need more explanation. It is important that this not be perceived as testing the patient/family, but rather to avoid any misunderstandings, for example:

“I know that was a lot of new information. Who are you going to talk to about this meeting today? To make sure I did a good job of explaining to you, can you tell me what you are going to say to them?”

Adapted from [47]