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.