August 2020 Communication Tip

Serious Illness Conversation Guide Step 3: Sharing a Prognosis

This month’s communication tip continues a review of Atul Gawande’s Serious Illness Conversation Guide (SICG), a proven aid for busy clinicians to discuss Goals of Care with patients facing serious illness.  Checklists work!

Previously, I reviewed Step 1:  Getting Permission to talk about goals of care and Step 2: Assessing Understanding. This month, I encourage clinicians to try out Step 3:  Sharing a Prognosis.

After getting permission to talk about goals of care and assessing a patient’s understanding of their illness, your next task is actually sharing the prognosis.

You might start with something like:

“I want to share with you my understanding of where things are with your illness...”

Then you can deliver the prognosis clearly and succinctly.

Consider framing your prognosis as a “Wish… Worry” or “Hope… Worry” statement.

And talking about possible outcomes related to Uncertainty, Time or Function.

Here are the examples from the guide:

Uncertain:

“It can be difficult to predict what will happen with your illness. I hope you will continue to live well for a long time but I’m worried that you could get sick quickly, and I think it is important to prepare for that possibility.”

OR

Time:

“I wish we were not in this situation, but I am worried that time may be as short as ___ (express as a range, e.g. days to weeks, weeks to months, months to a year).”

OR

Function:

“I hope that this is not the case, but I’m worried that this may be as strong as you will feel, and things are likely to get more difficult.”

This is powerful communication.  Remember to give your headline statement and then allow for silence and the likely emotions to follow.  This is hard work, but we have the rest of our careers to practice!

All My Best,

mike