TABLE 3.

Techniques/strategies to use in clinical cases 1 and 2

Issue	Techniques/strategies to address the issue
Tension around patient autonomy and surrogacy	Elicit patient communication, informational, and decision‐making preferences early (including who should be with them to receive information) and document their preferences in the medical chart to inform other health‐care providers. “Some people like to know all the details, while others prefer an overview or to have their family hear the information and then share with them. What is your preference?” Explore who the important people are in the patient's life/care so that you can include the right people in any life‐changing decisions. Do not assume a particular family structure, and remember that a patient's informal/unpaid family caregiver may be different from their surrogate decision‐maker (i.e., health‐care proxy). “Who should participate in discussions about your care?” “Who helps you with your care?” “Have you ever named a health‐care proxy?” “Who are your biggest supports?” Who can you ask for help in complicated cases? Social work Legal Palliative care
Communication between language‐discordant patients and physicians	Offer the use of a trained medical interpreter during clinical visits. “We want to allow everyone to participate and understand the conversation.” “We would like for you to be able to listen and be [family role] and not have to play the role of interpreter.” Pre‐meet with interpreters to brief them about the planned content of a patient/family meeting, particularly when sharing serious news, to discuss interpretation approaches and clarify topics/terminology that will be discussed during the meeting. In‐person/video interpreter preferred over telephone interpreter
Mismatch in patient/family and team prognostic expectations	Ask: Ask for the latest information that they have been told Ask permission to proceed Tell: Deliver news using a short, declarative statement without jargon and then stop Ask: Explore with open‐ended questions Ask what they understand (“teach‐back”)
Patient/family share importance of religion/spirituality	First, try not to dismiss the important role that spirituality/religion may play for patients/families, especially at the end‐of‐life. Affirm and meet the patient/family where they are with statements like: “We share your hopes” “What would a miracle look like for you?” “What are your biggest sources of strength?” Who can you ask for help? Chaplaincy or clergy referral if available Palliative Care Social Work Offer involvement of religious figures from their community
Patient/family name racism in the encounter	Ask open‐ended questions like: “It sounds like you have concerns about racism, would you like to talk more about that?” “How can we best support you right now?” “Is there someone we can connect you with who you trust?” Avoid terminating statements like “you will get through this” that may discourage people from bringing up their concerns. Conduct meeting with an interdisciplinary team whenever possible. Ask permission to involve others if appropriate: Trusted members of their community Patient advocacy Social work and/or chaplaincy