Table 3.

Key Communication Skills to Involve Patients or Surrogates in Treatment Decisions

Communication skill
Establish a trusting partnership Meet regularly with patients and/or surrogates Express commitment to patient and family Involve interdisciplinary team in supporting the family
Provide emotional support Acknowledge strong emotions Convey empathy Explore surrogate’s fears and concerns
Assess patient’s or surrogates’ understanding of the situation Ask open-ended question about what patient or surrogate has been told.
Explain the medical situation Use simple language to explain patients illness “Chunk and check” - convey information in small aliquots with frequent pauses to assess understanding Convey prognosis for both risk of death and risk of functional impairment
Highlight that there is a choice Explain that there is more than one reasonable treatment choice with different risks/benefits. Explain why surrogates’ input is important
When necessary, explain surrogate decision-making Explain surrogate’s role to promote patient’s values, goals, and preferences. Explain substituted judgment
Assess patient’s/surrogate’s role preference Discuss patient's/surrogate's comfort making decisions at that moment Explain the range of permissible decision-making models
Explain treatment options Describe the treatment options, as well as their risks and benefits.
Elicit patient’s values, goals, and preferences Elicit previously expressed treatment preferences (oral or written) Elicit patient’s values about relevant health states Ask surrogates what the patient would likely choose if he/she were able to speak for himself/herself.
Deliberate with patients and surrogates Discuss the advantages and disadvantages of various diagnostic and therapeutic options Explore patients’ or surrogates’ thoughts and concerns Correct misperceptions Provide a recommendation and explain rationale underlying recommendation
Make a decision Agree on a treatment decision to implement

NB: There is considerable uncertainty regarding the best strategies to achieve the tasks described in the table. Clinicians should therefore consider these recommendations as a conceptual roadmap for clinicians, rather than as a set of clinician recommendations.