goals of care conversations training reframing: we’re in a different place
TRANSCRIPT
- Slide 1
- Goals of Care Conversations Training Reframing: Were in a Different Place
- Slide 2
- ii Reframing: Were in a Different Place
- Slide 3
- Goals of Care Conversations: A Five Part Series 1Delivering Serious News 2Reframing: Were in a Different Place 3Mapping the Future: Clarifying Priorities 4Aligning with Patient Values 5Conducting a Family Meeting
- Slide 4
- Setting Perception Invitation Knowledge Empathize Name Acknowledge Summarize/Strategize Review: Delivering Serious News SPIKES
- Slide 5
- Since Last Time, Have You Delivered Serious News? What went well? Any challenges?
- Slide 6
- Goals of Care: What Makes these Conversations Tough? Expectations Uncertainty Emotions And the lack of a framework within which to enter the conversation
- Slide 7
- What We Will Learn REMAP: A Talking Map for Goals of Care Conversations
- Slide 8
- How We Will Learn Define skills (lecture) Observe skills in action (videos) Practice (drills)
- Slide 9
- Reframe Expect emotion Map out whats important Align with patient values Plan treatment to match patient values REMAP: Discussing Goals of Care
- Slide 10
- The message: you have an illness that could get worse in the coming days/weeks/months - we need to think about the future Bad news needs to be processed BEFORE moving on to decision-making Goals of care should not be discussed at the same time as really serious news REMAP: Reframe
- Slide 11
- Given where you are in your illness, it seems like a good time to talk about where to go from here Were in a different place than we were [X] months ago worse REMAP: Reframe (examples)
- Slide 12
- Most patients will have an emotional response to hearing the reframe. This is normal. The emotional response might sound like a factual question: Isnt there something else you can do? Are you sure weve looked into everything? REMAP: Expect Emotion
- Slide 13
- Respond to emotion with empathic statements Even if the patient is asking a question Use Name and Acknowledge Ask permission before moving on REMAP: Expect Emotion (Responding)
- Slide 14
- I can see that you are really concerned I get a sense that this is not what you were expecting to hear today Is it OK for us to talk about what this means? Ask permission before moving on REMAP: Expect Emotion (examples)
- Slide 15
- REMAP: Reframe and Expect Emotion
- Slide 16
- What did you see?
- Slide 17
- Time to Practice!!
- Slide 18
- Review drill as a group Divide into pairs to practice the drill Practice the drill script (person with bigger feet goes first) Switch roles Debrief with one another: How did it feel to speak the clinician role One thing clinician role noticed while doing this One thing patient role noticed about clinicians delivery Drill Instructions
- Slide 19
- Drill: Reframe ClinicianPatient Im not getting better with this treatment, but theres got to be something else out there. (Improvise) Tell me what you understand about your illness I wish we had a more effective treatment
- Slide 20
- Drill: Swap Roles PatientClinician
- Slide 21
- How did it feel to say the words? One thing clinician noticed One thing patient noticed Drill: Debrief
- Slide 22
- Drill: Reframe 2 ClinicianPatient I know Ive got COPD, and my breathing has gotten worse over the last several weeks. But Ive had this for quite a while, and it will probably get better (Improvise) What is your sense of where things are? You have been living with this disease a long time. And, I think were in a different place now.
- Slide 23
- Drill: Expect Emotion PatientClinician I cant even imagine what its like for you to be hearing this. So, what are you saying that Im supposed to give up? (Improvise)
- Slide 24
- Drill: Expect Emotion 2 ClinicianPatient Im a fighter. I know I can still beat this thing. (Improvise) Its probably a good time to step back and talk about where we go from here. I really admire your spirit and everything youve done to keep on living despite your illness
- Slide 25
- Drill: Moving Forward ClinicianPatient Youre right. Ive just kept hoping that the treatments would work. (Improvise) I can see how disappointing this is for you. I was hopeful too Would it be all right if we talked about where we go from here?
- Slide 26
- How did it feel to say the words? One thing clinician noticed One thing patient noticed Drill: Debrief 2
- Slide 27
- Where do you think youll get stuck? What do you want to take forward?
- Slide 28
- REMAP: A talking map for goals of care Reframe Expect Emotion Whats one thing youre going to try this week? Summary
- Slide 29
- Goals of Care Conversations Goals of Care Conversations training materials were developed and made available for public use through a U. S. Department of Veterans Affairs contract with VitalTalk. [Order VA777-14-P-0400] Materials are available for download from VA National Center for Ethics in Health Care at vaww.ethics.va.gov/goalsofcaretraining.asp.