I'm leaving it in God's hands
I'm hoping for a miracle
“At the end of the day, we are in God’s hands and it is his decision when to call us. While you are with us, I want to make sure I can help you as much as I can. one of the ways to give you more care that will help is with hospice"
What is the miracle you are hoping for?
MY MOM IS NOT DYING!
“I can see that this is really upsetting for you.”
“What thoughts or questions are on your mind right now?”
You just want to let my loved one die!
“What is happening is not up to me or any doctor. I cannot even start to imagine what this would be like if I were in your shoes.
“We are not here to let her/him die. We are here to help you deal with the unavoidable”.
starting SIC with compassion
This has been a tough time for you and your family, and you have faced the challenges of this illness with great courage.
I want everything done to bring me back.
Chest Compressions happen when your heart stops and you die. When you die as a consequence of (enter condition) the likelihood of getting back a heartbeat is minimal
God will take care of everything- AMEN!
Use the AMEN mnemonic
My mom is my best friend, I don't want to lose her!
“Our team will do our best to support you throughout this time.”
“I will keep you in my [thoughts] or [prayers].”
Why do i need hospice? i can get home health.
“We are part of the “everything”, we are not here to take away but to provide care.”
“I agree with you, I would want the same as well and that’s why we are here. The idea has never been to leave you alone when things get harder”.
“I’m glad you are telling me this, I am here to make sure your wishes are followed”.
starting SIC with questions about the future
“Do you have any questions or other concerns?”
“Is there anything you would like to ask me today about (enter disease)?
“Do you have any thoughts about where things are going with your illness?”
My goal is to get stronger so I can get more treatment.
Every person is different. I can only tell you what usually happens to people in your situation, not exactly what will happen to you. With your condition(s), you are likely to have good days and bad days but overtime you will continue to get weaker, unfortunately.
God will bring a miracle!
“It is God’s role to bring the miracle, and it is my role as your physician/NP/RN to bring you some important information that may help us in our decision making.”
Goals of care conversation when family lives out of town
“Is there anyone else you would like to be here with you while we talk?”
“Who else would you like to be present while we talk about this?”
“Is there someone else you would like me to involve or speak to?”
I'm not dying! Hospice is for people who are dying.
We have done a number of tests . . . The results show that . . .
“Of course, I don't have a crystal ball. However, in my experience with people with tumors like yours, things often change quickly when the tumor has spread to so many different areas. I wonder if you have any questions about what comes next.”
add stats, and objective signs of disease progression
starting SIC by asking what the patient knows
“Can you tell me what the doctors have said to you about your illness?
“I am very happy to answer that, but do you mind telling me what made you ask that question?”
“What are you expecting to happen?”
“How you live the rest of your life is your decision. By now you already know what going to the hospital does for you. You can stay home too and be comfortable.”
I have hope that Dad will recover!
Hope is important. Sometimes what we hope for has to be reframed. Since hope for a cure is not possible at this point, we hope that Dad is feeling well, his symptoms are controlled and maintain his dignity.
I want my loved one to get more treatment.
“There’s always risks and benefits with the treatments, have you asked your doctor if you are more likely to experience the risks than the benefits?”
We are here to make sure he/she is comfortable. At this point hospitals or aggressive therapies will not help him/her live longer. If we could save her/his life, we wouldn’t hesitate to tell you”
We help patients during this [process] or [journey] or [transition]. We are here to answer questions that come up when usual therapies stop working or cause harm”.
My friend's mother went to hospice. She died as soon as she got there.
Tell me about this situation .....
Often patients come to hospice very late. The majority of patients spend less than one week in hospice. We are having this conversation now so we can get you the additional help and support you need at this special time in your life earlier.
starting SIC by addressing fears
“What worries you the most about the future?”
“What do you hope for the future?”
“What is your biggest concern at the moment?”
I don't want to talk about hospice!
“Can you help me understand why you don’t want to talk about your prognosis?”
“I understand you don’t want to talk about this. How about you tell me what good and bad can come out of having this conversation?”
“I understand this is difficult to you, would you like to stop and continue the next time I see you?”
I'm not giving up hope!
Tell me more about what you are hoping for? What does having hope mean to you?
I want my loved one to get more chemotherapy.
“Chemotherapy at this point is aimed at prolonging your life by a few [weeks/months/years]. Treatment can shrink the tumor which in turn should make you feel better, but it can also cause complications and even death”
“Chemotherapy has the potential to benefit of prolonging your life, but it comes at the cost of the quality of life you have left”
I know they will just give her morphine.
Morphine is used to treat pain and shortness of breath. It is only given when it is needed to treat these symptoms. The dose that is typically started is equal to one norco, or vicoden. It is not the strongest pain medication we have but it is one of the oldest. It is widely used in hospice because it comes in a concentrated liquid that is easy to swallow than liquid vicoden which is very thick and has to be given in a large volume. It also does not contain tylenol like vicoden does so if the dose needs to be repeated or adjusted - it can be done easily with the same bottle of medicine.
Keeping HCS or other decision influencers informed
“Is it OK with you if I tell your [relative/caregiver] what I’ve discussed with you?”
“Often [daughters/sons] like to ask detailed questions. Is it okay if I answer your [son’s/daughter’s] questions? Is there anything I should not discuss?”
I want everything done.
Tell me more about what everything means to you?
What specific treatments are you concerned you are not getting or can't get?