Background/Methods For the setting of serious illness communication, there continues to be variable understandings of, and definitions used, for the terms advance care planning (ACP) and goals of care discussions. Aiming to clarify as well as improve serious illness communication, consensus definitions along with several education resources, programs and quality improvement interventions have been developed. Our collective experience however is that confusion regarding these communication tasks persists. As more people are living with serious illnesses, the need to provide clear guidance to clinicians grows increasingly urgent.
Results The Preparing or Deciding (POD) Model is a framework that helps clinicians understand the overall purpose, tasks, specific outcomes and their role in serious illness communication. It posits that at a high level, conversations with seriously ill people are about either preparing or deciding. In practice, during any interaction involving serious illness, a clinician asks themselves: Is a treatment or care decision needed? If yes, conversational approaches that support decision-making processes are needed. If no, focus is on preparing patients and families for progressing illness and future decision-making.
The POD Model frames preparing or deciding as mutually exclusive, contrasting many clinicians who conflate the two and rely on ACP (preparing) for decision-making about interventions that may or may not be offered. This approach is ineffective; advance directives frequently fail to guide decision-making or improve the delivery of goal-consistent care. Despite jurisdictional differences in clinical and legal frameworks that support serious illness decision making, the POD Model applies universally, is applicable in every care setting and to all healthcare practitioners.
Discussion The POD Model guides clinicians to support decision-making when appropriate, and otherwise understand that conversations addressing serious illness are to prepare. When clinicians better understand their role in serious illness communication, individuals and systems can more effectively move improvement efforts forward.
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