Communication model | Serious Illness Conversation Guide28 | ADAPT29 | PREPARED30 | SPIKES31 | The four habits model32 |
Components | Set up the conversation Assess understanding and preference Share prognosis Explore key topics Close the conversation Document your conversation Communication with key clinicians |
Ask what the patient knows, Discover what information about the future would be useful Anticipate ambivalence Provide information Track emotion |
Prepare for the discussion Relate to the person Elicit patient and caregiver preferences Provide information tailored to needs of patients and their families Acknowledge emotions and concerns (Foster) Realistic hope Encourage questions Document |
Setting Perception Invitation or Information Knowledge Empathy Summarize or Strategize | Invest in the beginning Elicit the patient’s perspective Demonstrate empathy Invest in the end |
Created/sponsored by | Ariadne Labs-MGH, National Advisory Group, United States, 2012 | VitalTalk National Institutes of Health funding, 2012 | Expert Advisory Panel, New Zealand, Australia, 2007 | MD Anderson physicians, 2000 | Kaiser Permanente, 1995 |
Introduction/environment | Set up the conversation
| Prepare for the discussion
Relate to the person
Show empathy, care and compassion during the entire consultation | Setting up the Interview
Manage time constraints and interruptions | Invest in the Beginning
Plan the visit with the patient “I understand that you're here for… Could you tell me more about that?” – “What else?” | |
Patient’s understanding and preference | Assess understanding and preferences | Ask what the patient knows, what they want to know Discover what information about the future would be useful for the patient (statistics vs living to a particular date) Anticipate ambivalence | Elicit patient and caregiver preferences
| Assessing the patient’s perspective
Obtaining the Patient’s Invitation
| Elicit the patient’s perspective
Explore the impact on the patient’s life |
Prognosis | Share prognosis
| Provide information in the form the patient wants | Provide information tailored to individual needs of both patients and their families
| Giving Knowledge and Information to the Patient
| Invest in the end
|
Respond to patient’s emotion | Allow silence, explore emotion | Track emotion | Acknowledge emotions and concerns
(Foster) Realistic hope
| Addressing the patient’s emotions with empathic responses
| Demonstrate empathy
Convey empathy nonverbally |
Goals | Explore key topics
| (Foster) Realistic hope
| Strategy
Understand important specific goals | Elicit the patient’s perspective
Invest in the end Involve the patient in making decisions | |
Conclusion | Close the conversation
| Encourage questions
| Summarize | Complete the visit
Assess satisfaction | |
After encounter | Documentation
Future plans
| Document
| |||
Validation | RCT34 35 | RCT39 | Not validated | Observational study40 | RCT51 |
RCT, randomised controlled trial.