Table 5 Serious Illness Conversation Guide for the disaster medicine setting

Setting up the conversation

--Introduce purpose of the conversation

--Ask permission

--“I’d like to talk about what’s been happening with your mother’s health situation. Would that be okay?”

Assessing the prognostic awareness

--Elicit patient/family illness understanding

--Explore hopes and worries

--“What is your understanding of how your wife is doing?”

--“Are there things you are hoping for in terms of her health?”

--“What are you worried about?”

Share worry

--Disclose condition/prognosis

--“Because of the injuries your father experienced in the earthquake, I am worried that time is quite short for him.”

--“I hear you are hoping that we’ll be able to treat your son’s cholera, and I’m worried that even with the medicine we are giving him, he may die from this.”

Align

--Align with patient/family through:

-“I wish” statements

-Naming emotion

- Exploring emotion

--“I wish we had a treatment that could fix your sister’s injuries.”

--“It sounds like you are shocked to hear this.”

--“This must be so difficult to hear.”

--“Can you tell me more?”

Explore what is important

--Explore the patients’ fears, worries, goals, sources of strength, and family support.

--“You mentioned that your mother’s faith is a source of strength. Are there rituals it would be important to perform at this time?”

--“Often patients have worries about dying in pain. Do you think your husband may worry about that?”

Close the conversation

--Summarize the news given

--Make a recommendation

--Affirm commitment to the patient and family

--“I’ve heard you say that your faith is very important. Keeping that in mind, I recommend that we try to find a priest who can visit as soon as possible.”

--“It sounds like you are worried about your mother’s labored breathing. I recommend that we give her medications to ease her breathing and ensure that she is comfortable.”

--“We will do everything we can to help you through this difficult situation.”