October 2020 Communication Tip

Serious Illness Conversation Guide Step 5: Close the Conversation

This month’s communication tip completes the 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. 

In previous months, I reviewed

Step 1:  Getting Permission to talk about goals of care

Step 2:  Assessing Understanding

Step 3:  Sharing a Prognosis

Step 4:  Exploring key topics.

Finally, we’ll conclude with Step 5:  Close the conversation

The key goals for completing the conversation are:

• Summarize
• Make a recommendation
• Check in with patient
• Affirm commitment

Here’s a script you can try:

“I’ve heard you say that ___ is really important to you.

Keeping that in mind, and what we know about your illness, I recommend that we ___. This will help us make sure that your treatment plans reflect what’s important to you.”

“How does this plan seem to you?”

“I will do everything I can to help you through this.”

Finally, after Step 5, it is important to document your conversation in APEX and communicate the conversation with key clinicians… this is done easily in the ACP navigator (type “.ACP” in any APEX note ).  The ACP Navigator collects all the advance care planning information for a patient in one highly-visible place in every patient’s APEX chart.

All My Best,

mike