Explore Expectations
Goals of care are sometimes shaped by what seem like unrealistic expectations — “Dad has always been a fighter” or “she’s just waiting for the miracle” — or a lack of understanding of the situation — “he just needs a little tune-up.” Giving caregivers an opportunity to talk about their loved one, to describe their personalities and values and beliefs, often allows them to start moving to a more realistic perspective. Exploring expectations provides an opportunity for education and allows people to be clear about their goals. Families look to the Emergency physician for information, empathy, and guidance.
- Watch the video below for an example.
Discussion: Explore Expectations
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Great empathy and transitions into important questions
h
compassionate and caring and truthful
patient focused
compassion
reflection is powerful
very compassionate
compassionate and sympathetic
aa
very empathetic. allowing the family to go over the patients true wishes whilst attending to the family
Compassionate discussion. Empathetic provider advocating for family and patient
compassioate discussion. Empathetic provider advocating for family and patient
good
ED provider was empathetic. He is trying to understand his patient by talking to family member as well as trying to advocate for patient.
Agreed. He does a great job of listening and then advancing the conversation.
very compassionate and empathetic. He took his time with the family and allowed the patient’s wife to speak
very compassionate and empathetic
Great empathy
Great empathetic approach. Provided a safe and fostering environment for family member to talk about husband’s wishes.
Good.
Ohk
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Great way to start the conversation to end the patients life. Treating the patients life with dignity, and specially making the family remembering them how they where and what would they like before.
agreed
Impressive
good job
amazing
k
9
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ok
ok
Good approach
nice way to assess expectations
I agree
great approach
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ok
ok
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good empatetic aproach, soft nice proffesional
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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.
ED doc looked attentive and in the moment with patient’s wife.
Empathy goes along way!
great approach
great approach
great approach
Allowed the caregiver to maintain control
Excellent video showing the right approach when discussing gaols of care. Gentle and empathetic physician.
very well detailed
great video
empathetic approach
communication is key!
this bottom button that is automatically checked off and says we want followup emails is annoying and should not be there
he was patient and kind
living WILL it is so important
Good to get family perspective
yes
good listening
Empathetic approach. Talking about what pt would have wanted has made family member realize goals of care.
Empathetic approach. Talking about what pt would have wanted has made family member realize goals of care
good therapeutic relationship development and maintenance
very empathetic approach
good communication, listening to family
Talking to everyone individually would take a lot of time, but it may also give you a chance to understand where everyone stands on the issue at hand without the judgement of others.
asked about the family member and how he used to be – empathetic and caring.
asked about how the pt would like to be cared for
Great approach
Empathetic approach
listening and being emphatic
sympathetic
Solid empathic approach
Sympathetic approach
great communication
Excellent communication skills
good approach
Important
great approach
empathy is truly impt to develop to care for pts
Great approach, empathy and communication skills
Good way to go about extracting that information
good discussion
taking the time to get to know who the person is/was rather than just focusing on their medical details is so important – it helps establish goals of care but also shows that we respect and care for them.
Great approach, empathy and communication skills shown.
agreed
good and careing diacussion
Empathetic, explored the wishes of the patient via the wife.
great approach, expectations, empathy
great approach, also he should asked the wife how she was doing?
Again, the healthcare provider is empathetic and focuses on goals of care that are congruent with the feelings of the family and directives provided previously by the patient.
Very good approach.
Should have asked her if she was comfortable with the plan
Be compassionate !
listening is so important. the environment is counterintuitive for this to happen (the ED) but thats exactly what will give us the answers for caring for this patient
Good empathy
He was very good at listening and then having the best empathetic response to get the info he needed about the patient. This also allowed his wife to reflect on her husbands wishes not her own for him but gently accept and be part of the goals of care. Good examples to learn from
Good approach focused on the wishes of the client, not what can/ should be done. Focused on comfort of the patient.
excellente.
excellent approach to discuss the topic of goals of care
Well done. Very good approach.
Great listening
Appears to really care and be there with the wife
reassuring
it was great..this is the technique often used in practice. One does come across situations when the family is not ready to accept the situation and final decision is to be made unilaterally by the EPs. That is also a skill to be picked up otherwise it will lead to lots of” machine and tubes” which patient does not need or did not want or is futile!
Now with the introduction of MAID, this could be another possible topic but not in this particular case where the client has dementia or cognitive impairment.
…..
it is excellent to give family the option of talk about…
calm, patient, open approach
Empathetic, practical approach
great approach
the approach was really good,good communication and giving time to spouse to elaborate.
Humane and pain free are the main objectives,
buenas recomendaciones
exc options
talk whit true
La evaluacion del cuidador es delicada
dont give false expectations
gggg hr
pppp
I thought the physician’s approach was good. The focus is on what the pt. would want. In response to the question regarding the possibility of the family asking to have everything possible done to save the pt. life, it has been my experience that we then do everything possible to prolong the pt. life. When our attempts are unsuccessful we stop.
The physician gave her the opportunity to reflect on the live they lived, and that in away can ease to transition of accepting the worst out come possible.
Allowing the patient to talk out loud about who the person really is can allow the family to come to an understanding themselves about goals of care.
expectations
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The approach was empathetic, the doc and wife created a therapeutic relationship to ensure the patients needs and wishes were being met.
Not sure we should go along with the wish to get it over as soon as possible, but the other goals are easy to achieve.
empathetic approach
Good way to start with pt’s condition and then moved to the family for plans.
I like that he starts off with asking about her husband and what he was like and then goes into what he would want for end of life care. Empathy and respect for family was shown
well done
easy to understand language to explore expectations, didn’t use any medical jargons or talk about code status/resuscitation, but obviously has the answer to that now.
I like how the MD gave the wife to first tell him about her husband, starting off on a positive note is good for patient and care-giver rapport.
I like that this doc was not afraid of silence he allowed for further expression and he used touch when needed to express support and understanding
The ER doc did this nicely. He used an open ended question approach and got the wife to talk about her husband and what he would want to see happen. Based on this discussion the ER doc would have a better idea of the treatment approach to take so that the husband’s wishes would be respected.
Very nice approach and discussion. How could MD respond if patient’s wife had replied, “he would want everything done”?
(Assume MD explained futility of resuscitation, invasive measures causing increased distress, pain etc, no realistic chance of good outcome…. and family still wants “everything done”?)
wife is in full agreement with husband’s wishes end of life dignity comfort measures realistic goals are about to be attainable
Might consider exploring the comment “God would pull him through” to make sure that the patient and wife have had their spiritual needs fully addressed.
by starting with the reflection on the patient’s ;life I think was a good approach to focus on the goals. Very sympathetic approach.
focus of care would be symptom control and comfort care dnr
the approach of the ER MD was sympathetic it gave the spouse an opportunity to reflect on her husbands life and current decline also to express his previous wishes, it helped clarify the goals of care