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Patient Values: Three Important Questions—Tell me more? Why? What else?
  1. Shunichi Nakagawa1,
  2. Mary E Callahan1 and
  3. Ana Berlin1,2
  1. 1 Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
  2. 2 Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
  1. Correspondence to Dr Shunichi Nakagawa, Medicine, Columbia University Medical Center, New York, NY 10032, USA; sn2573{at}

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Serious illness communication

When patients become seriously ill, clinicians must engage in difficult conversations to ensure that the care provided aligns with patient expectations, goals and values. In these situations, clinicians tend to focus on medical facts, present treatment options like choices on a restaurant menu, give detailed explanations for each option and request that patients or surrogates choose among them by asking ‘What do you want?’ or ‘What would they want?’ While these questions are well intentioned, they are seldom productive. The use of the word ‘want’ shifts the discussion from attainable goals and values to magical outcomes not grounded in medical feasibility and specific treatment options, such as dialysis or intubation.1 Yet, it is hard for patients and their surrogates to imagine what those treatment options realistically entail, and the resulting decisions are likely to be ill informed and goal discordant. Instead, clinicians are encouraged to explore patients’ values and priorities and make a recommendation based on them.2 3 Unfortunately, despite many serious illness conversation roadmaps,2 4 few guidelines exist for how to actually explore values. In this article, we provide suggestions for this crucial step in a serious illness conversation.

What are values?

Values are broad concepts that guide our actions and may include values of …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.