Choose Your Language Carefully
The Right Language
Conversations with patients at the end of life or from nursing homes tend to be negative — “we can’t treat” “there’s no point in . . . ” “she hasn’t responded to. . . ” “there isn’t a cure for. . . ” Instead, use language reinforcing that treatment and care are continuing even if the goals are changing.
- “I want to explore what your values are so that I can provide the care you and your mother want.”
- “Your mother’s wellbeing is of utmost importance so I want to know what approach is going to be right for her.”
- “I want to make sure your mother receives the kind of care she wants.”
- “Tell me what is most important to you when you think about the future…”
- Use “I wish” statements: “I wish there was a treatment that would fix this problem…”
- Talk about “allowing natural death” rather than “do you want resuscitation?”
The Wrong Language
Goal-oriented care is still treatment and often is an increase in the amount and intensity of care that the person is receiving. It’s important to avoid language that suggests “withdrawing” care, “stopping” care, or abandoning care.
- “Do you want us to do everything possible?
- “Do you agree to discontinue care?”
- “We’ll refrain from using extraordinary/heroic measure.”
- “Maybe it’s time to start pulling back.”
- “I think we should stop aggressive therapy.”
Discussing the patient’s values can be an ideal starting point for facilitating these conversations.
- Watch the video below for an example.
Discussion: Choose Your Language Carefully
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Doctor showed compassion when delivering bad news. He set clear expectations for the patient’s wife. It is advisable that he delivered the news in a quiet and private area (unlike in video).
bring support for family member. ask her to call someone or have someone with her at this time to help
I would likely have had a more engaging conversation before giving my prognosis
Physician seems kind, and I also try to be direct, but thought he could have started with a more compassionate statement.
Clear in the diagnosis and prognosis, empathic, overall an excellent example of what should be done
Estoy de acuerdo con la forma en que se lo comunicó, creo que fue educado, compresivo y bien explicito
could have elicited family understanding and requested permission prior to disclosing news. good that he provided a warning shot prior to discussion. and good to explore goals.
empathy, compassion, gentleness
compassionate, caring, truthful
Providing clear medical update in terms of his prognosis
Asking for what her husband would have wanted – rather than what she wants for him
Excellent use of SPIKES
compassionate and clear communication
Good bedside manner.
compassion, clear, direct to the point
The MD was compassionate in his care.
I agree the MD was compassionate and direct but I would have started by asking the wife about her understanding of her husband’s illness / condition, get an idea where she is right now. He did almost all of the talking with her just sitting there looking at him – little attempt to determine what she was actually taking in and understanding. So often this is seen as the ‘quickest’ way to get this through this situation but doesn’t always mean the person we are talking to is getting it to be able make decisions.
Laid out the prognosis very well and then brought in the patients values with the family
including the family is so important in the discussions
What pain meds is he on now, what symptoms is he having at this time. Do they have home care support? Is there any opportunity to let him die at home? What supports does the wife have? Do they have any family who might want to say goodbyes?
clear, honest conversation. Maybe a bit more compassion though
ED physician was clear, concise but empathetic.
Given the ED environment I think this ED physician was very direct and clear but also compassionate. He asked about what the patient would want his end of life to look like and how they could proceed given the trajectory to death was soon.
Reasonably compassionate, unfortunate interruptions, did well in expressing the urgency of time and left opening for wife
clear and direct information
for compassionate reasons
Be honest and upfront, but yet compassionate. Ensure they understand the severity. Offer support
end of life issues and difficult and palliative care is the way to go
palliative care practioners can be great resources
Calm and excellent approach by provider.
noisy environment and he should have allowed the patient’s wife to speak.
patient, direct, compassionate
Good allowing her to give an insight into what patient would want
Dr. was caring, compassionate towards the situation handled it well.
THE DOCTOR WAS STRAIGHTFORWARD, INVOLVED THE SPOUSE PARTICIPATION IN WHAT THE DYING PATIENT WOULD WANT AS THE SPOUSE WOULD KNOW HIM BEST.THE TIMELINE FOR DEATH WAS VOICED RATHER ABRUPTLY TO THE SPOUSE AND SHE DIDN’T GET TIME TO ASSIMILATE THAT INFORMATION.I DO NOT AGREE IN PREDICTING TIME TO DEATH. ACCORDING TO THE HIPPOCRATIC OATH;THIS IS NOT AN ACCEPTED PRACTICE.REALISTICALLY,PROGNOSTICATION WOULD ALL FOR BREAKING BAD NEWS IN A MORE HUMAN WAY.I BELIEVE THIS ALLOWS THE SPOUSE TO GRIEVE BETTER.
talked slow and explained clearly, gave timelines and asked to clarify goals for end of life care
took the time to do one on one and give her time to compose
liked how the questions were more open ended. Liked that he framed it as what would your husband’s wishes be regarding GOC
good open ended discussion and allowed pt time to speak. Maybe a more quiet area would be good
Straight forward, No negative language, gave information and trying to understand goals
The doctor is very honest and realistic and focusing on the patient’s goals of care
the physician did great. He is honest, direct and did not use any wrong language.
the dr. is looking out for pt’s best interest and wishes
he did great, didn’t use the ‘bad’ phrases, asked what the husband would’ve done if he could decide for himself
I think just missing physical contact, what he said is clear
no jargon, clear, sitting at eye level and showed compassion
I thought that the ED physician did a really good job. Compassionate, direct, no wasted words, no medical terms, focusing on the reality of the situation. Making sure that the patient’s wishes are followed.
very clear about patient’s current situation, giving all information necessary to the relative. Good interview especially on this touchy subject.
compassionate but giving clear information about pt’s prognosis, listening to what spouse thinks patient’s wishes are
Compassionate and transparent conversation, with engaging the wife
Honest and direct with compassion.
Did a good job making sure wife understood how ill her husband was. Good job asking what goals of care patient would want.
Very clear and direct. Shows compassion with body language, listens attentively. Perhaps he could have asked her to clarify that she understands (did give her significant news) before proceeding.
clear, direct honest, good but a bit hard on lady.
I will also assess her ability to take a bad news
The doctor did wonderfully, I will have given some warning though by asking the wife about his prior functional status and accertaining her understanding of the situation.
hard but important top
comprehensive, direct, caring
Clear consise information with empathy.
Communicated well with pt’s spouse re: prognosis and obtained information re: goals of care effectively.
this was a good conversation
know the patients needs.
direct and caring
direct and honest
good comparison of what to say or not to say
honest and clear
MD was very direct
direct and honest
Great Direct conversation by the provider but good for the wife to make an informed decision in a difficult situation
Direct and honest. Allowed caregiver to help with decision making.
Very direct and honest. Used clear, concise language. Was compassionate but could have had more empathy. I would have anticipated the conversation to also be in front of the patient to involve his opinions as well.
considerate, honest, compassionate
Very honest and provides prognosis to wife, likely affirming something she already understood previously which makes it easier to focus on goals. Empathetic. Might be appropriate to involve other family members or find room where announcements wouldn’t be heard during conversation.
asking about the patient’s wishes
choice of words are important in delivering such news. Although the news may be bad, empathy, understanding and compassion is also important
uses spikes methods
the doctor from the beginning used the SPIKES methods. He started the interview in a private room, got the patient perception of her husband illness, invited her to give her feedback and information towards the care of the husband. he gave his prognosis and although he used some works i didnot like and his approach was sincere truthfully but slightly harsh
well framed conversation
Difficult conversation to have. Perhaps could have asked if there were any family members she would want present during information and discussion so that she would have support.
good info to have thank you
A good encounter. He warns her that the discussion will be a difficult one, he addresses prognosis, but he could have probed her perception of her husband’s condition & overall prognosis better. The location is not ideal as there are many potential distractions. He asks whether the wife knows or has discussed with her husband what he would want in the event he was this sick and couldn’t express his wishes.
explored goals of care
generally ok Better space would be optimal, build bit repore before jumping into prognosis. Ask about how she is seeing her husband and expectations. Ask more about how home is, what wife’s thought of comfort and pain control is etc
hard but important top
Liked the fact he took her to a private space and was compassionate, asked her directly what would her husband want. Also being truthful about the imminent death.
compassionate, asks about patient’s values and goals
nice, compassionate, well framed conversation
A well framed conversation, respectful, honest and compassionate
Listening to pt’s wishes
patient’s wish is a key
Good to ask what the patient would want if he could speak for himself.
empathy and compassion are key
its a hard conversation to have, esp about death prognosis
The conversation was very clear, focused, and directed towards the patient’s goals and needs during end-of-life.
He elicited the wife’s response in a gentle and caring manner. He explained the gravity of the illness.
I liked that he was very accurate and truthful with the fact the patient will die soon rather than using language which dances around the issue or does not directly state, “he will die”
Importante la interacción del médico e la forma d expresar el pronóstico así como conocer las expectativas del paciente y la familia
important that the doctor made his prognosis very clear and asked about his wishes
calm and compassionate but try to avoid jargon and terms like “goals of care” – this means very little to patients. also he talked to her for several paragraphs before interactively assessing what her understanding was
agreed! great point
The doctor didn’t explore what the wife’s perception and knowledge of what was going on before sharing. However, did a good job exploring what the patient would want in terms of goals-of-care.
Could have done a better job asking where wife was from knowledge standpoint and then filling in the gaps but good questioning on what patient’s goals would have been
This is a nice way to deliver awful news. The loudspeaker was rough.
empathic, clear communication
-Timeline was established
-Family was involved to provide insight on pt’s values and wishes
-Could have made better use of a quieter environment to have this discussion
use empathy awknowledge the person’s loss and let them know there are support systems within the healthcare system for them to help guide them / support them throughout their decisions
strange to use “I wish” statements.
straight to the point but with an empathetic tone
doctor was being blunt, although there was a minor disruption the environment was suitable enough for a sensitive discussion oh that nature. family member given a chance to add their input.
That doctor did great. Ver compassionate
Compassionate, clear and concise interaction
Calm non-threatening demeanour and engaging body language. Setting scene could be better, ++overhead interruptions. Could ask for SDM’s permission before launching into update. Gave time for her to fully express herself. Clear communication around prognosis.
understanding and good communication
clinician is sympathetic yet clear with his comment
He used good language to communicate with the wife, clear about expectations for death and clear about what his wishes would be, placing less on the wife to make decision of her own, but thinking about what her husband would want.
empathetic. gave a clear timeline (“hours to days”)
Excellent approach. Would see less issues with EOLC in ED if more people took his approach.
I would what honesty with compassion near my end. Pain control is important. The doctor allows the wife who knows him the best to voice her husband’s wishes as she sees them. Allowing her some time to absorb this information, letting her know that he will still be cared for, but in a manner he would choose
Clear language, sympathetic, always positive when talking about future goals. does not suggest removing care which is often how the discussion is framed.
Love how direct and to the point the MD is while still being compassionate. There is no ambiguity in what he is saying.
I appreciate how he warns the family member that this will be a difficult about the conversation, he also makes it clear that the client really is unwell – no uncertainty or false reassurance. Then listens.
health care provider used the right language
Allowing partner to share worries, being present. Identifying need to grieve and self care. Clear straightforward communication
Communication clear but a little dry
make sure to stay compassionate
any other communication techniques ?
Honest, good communication
honest with proper communication skills.
acknowledge pt choice
Always ask what would be the patient choice
It takes away the responsability from family members ho have to live with the decision they made
•Talk about “allowing natural death” rather than “do you want resuscitation
Be honest and direct but maintain compassion
always be honest
Very upfront and honest approach. However, it must be hard for a family member to respond to his question adequately after just having been told the patient may die within a few hours (if there was any level of denial of the patient’s condition, which there often is…).
set the stage well, did not use euphemisms, sought the patient’s goals of care directly
Honest expectancy with proper communication skills.
Asked what he would have wanted if he was able to speak for himself.
Respected patient’s / relatives desires.
clear open communication
being realistic and honest
Established treatment goals. Open and clear communication.
good clear honest
Appropriate and kind
Very focused and set goal oriented communication
Clear communication, was clear with his expectations of the patient’s health, and goals of future care.
Very clear communication. Asked Wife what his wishes would have been.
clear communication, patient’s wishes is taken into consideration
The compassion in the health care providers voice was impressive and the word selection was also remarkable in that he focused on what the patient’s wishes for his care might be, maintaining a positive tone rather than talking about withdrawing care or not resuscitating, etc.
focus is on what the patient would want, goals of care. Also the prognosis is made very clear.
excellent. clearly explained the situation in terms she could understand and allowed her to verbalize her thoughts without giving her a multiple choice situation initially
He clearly and empathetically laid out the facts and then elicited her wishes/the patient’s wishes
Clear language is crucial but you must be kind while being direct
clear language, asked what the patient led want.
I think the setting is great, away from the patient and in a quiet area (until the overhead tannoy pierced the atmosphere! The doctors introduction was reasonable and clear but I wonder if the comment that “he may die” and “I expect he will die in the next few hours to days” may have been little hard for his wife to hear. Perhaps some inquiry first as to what she is expecting/ anticipating and gradually lead into a discussion about how ill he is and that infact he may not survive this illness. I personally prefer this approach rather than “he may die” which is a bit harsh for some people to hear. Good ongoing discussion tho.
too rough at the beginning but really good comunication of prognosis
No I dont..very interesting though
A LITTLE ABRUPT IN THE BEGINNING BUT DEFINITELY CLEAR ABOUT IMMINENT DEATH, PROGNOSIS AND THEN GENUINE EMPATHY AND CONSIDERATION OF BOTH THE WIFE’S AND THE PT’S WISHES TO ACHIEVE THEIR GOALS.
Begins by sharing information. Expectations about the course of illness are given clearly without being overly specific. Wife is given the opportunity to share her husband’s wishes.
Good opening discussion with the wife bu painting a poor prognosis with easy to understand and not misleading, language. Wife and by proxy husbands goals of care explored and planned to abide by.
Was honest about his prognosis for the patient and presented the discussion about what the patient’s wishes would be as his wife would understand them
I like the unambiguous information provided and the way there was plenty of time for the wife to talk; active listening.
asking the spouse what her husband would want
and expressing his concers
The MD made it clear to the ‘spouse’ what was happening but he didn’t confuse things by using any lingo, buzz terms, or catch phrases.
The conversation was sensitive and addressed the current situation without leading his wife but asked to respect the patients wishes and goals of care.
Good communication and empathy when the doctor was talking to the wife.
Taking into account what the patient and wife would want to be managed when he becomes seriously ill
Good choice of language, being frank while offering sensitivity. Seeking input from family member Re: goals of care
Allowed patients spouse to articulate what she thinks the pateint would want for his care
listening to their wishes
compassionate to allow the patient/family to address wishes without any prompting.
the prognosis is communicated clearly, opportunity was provided to allow family to decide what is important.
compassionate/ empathetic but still practical and direct.
I like how Dr. framed the prognosis part
The physican painted a bleak picture and then a bleaker one again.. Perhaps the simple statement
-Your husband is very ill and may die. … Pause
We want to care for him the best way possible. He is to sick to tell us his wishes
Could you tell what he would want us to do for him?
“Goals of care” is not always understood by families… plain and simple language only
Empathy is clearly exhibited. likely that the “tubes and machines” are attached before discussion….I would Offer:
1any other family member
3 Pastoral care offered
4 discussion of “active” comfort care
simple words, private room
Clear and simple language understood by the patient
I like the straight-forward statements. Using the word death and being very direct about expectations makes a big difference.
Clear and concise conversation with no room left for interpretation
clear language that can not be mis-interpreted
Clear language is essential
Good interaction in that the physician is seated and provides a good explanation. He also asks what the wife would like. A quieter location would have been nice and if family could not be present to support the wife, then perhaps spiritual care or social work could have been brought in to support the wife.
I think that this was a good approach. I do think he should have allowed the relative some time to think and talk earlier on as he said a lot without a break. I think he approached the question about next steps positively with a view on what the patient would have wanted.
This would be a quiet room conversation, and if she had family, this would be support for her…..Although his words were well spoken.
He started of well but then told the wife that he expected her husband to die within hours, he should have not used those words and break the news more slowly with better use of language, and also consider what the wife’s view and opinion on what is happening and what she understands about the clinical condition of the patient at the present time.
it was important to elicit the patient’s and relative’s views on his current state
Hay que explicar con palabras claras
clear communication, talk whit true
la realcion entre personal de salud y paciente es fundamental
Very important to use clear language.
la empatia es una parte muy importante de la relación medico paciente
He was empathetic, listened to the family
the physician asked the wife about what the husband would his treatment goals to be at this stage,and he was also frank on the prognosis.
The physician did a wonderful job of giving the wife the prognosis and allowing her to express what the husband would want to have done.
Suggest quieter setting. Discussed all the major points of prognosis and goals of care, possibly breaking it into chunks allow spouse time to reflect
Introduces and sets the stage nicely for the difficult discussion that’s about to be had.
Very upfront conversation about prognosis. “expect to die within a few hours to days”. “too sick to speak for himself”
What do you think HE would want in this situation? what would his goals of care be if he could speak for himself?
Leave the conversation open-ended with a realistic titration of expectations.
I appreciated the focus on the patient’s wishes.
Good therapeutic relationship
Compassionate and realistic discussion using appropriate jargon.
the physician was direct but yet sensitive
The ER Physician was clear and he involved the patient’s wife in plan, good approach.
the physician was very clear about the gravity of the situation and quickly moved to establish the wife as a person who could most accurately reflect his wishes in a situation where he himself could not communicate. Well done.
good compassion, discusses prognosis so family is aware and gets to the point of goals for care DNR etc
direct and to the point explaining the situation, and naturally leading to the question
Great introduction into a very difficult conversation by acknowledging this very fact.
good approach; to the point, asking if she had family that could be with her for support during the conversation may have been helpful also
It is important to use open ended questions to get the family to tell you what they would like to see happen and to get their goals of care
clear language that the patient could die. Also asking the caregiver about the patient’s wishes rather than saying “maybe we should withdraw care”.
I do many goals of care discussions. Good thing because I was unable to view this one. Despite refreshing several times
This approach is so much better than “there’s nothing we can do”.
dr started off compasionate with this is going to be a difficult discussion then rams it to the poor wife he is going die real fast. I feel he put a big burden on the wife asking what her husband would want. He wouldn’t want tubes and needles is the pat answer but doesn’t address the symptoms which we don’t know from the video what they are unless he is comatose.I know this is the emergency dept. but the gyn page in the background doesn’t help to calm the situation.
Refreshing. I am sure that a physician such as this would have inquired about other family members. I do wonder if the sub-decider was involved as soon as was possible, giving input into the desirability of the “tubes and wires” before they were attached to the patient. One of the more difficult things for an Emerg doc faced with a critically ill patient that is unknown to them.
The doctor did wonderfully, I will have given some warning though by asking the wife about his prior functional status and accertaining her understanding of the situation.
I think the Dr was proper to involve the wife on the decision making and also gather information rewarding the patient’s wishes. However I would have also considered the children involvement; this is and old lady herself she should have had some family support at this time.
the compassionate one on one encounter is very good i sense the family member is resolute and made at ease by the MD