Reframing: Focuing on Care that is Consistent with Goals
When discussing poor prognosis or cessation of an intervention, it is important to make sure that the patients do not feel “abandoned” or that the clinician is “giving up”.STEPS AND EXAMPLE
Notice how the clinician in the following examples does the following steps:
- Give patients a sense of control and set realistic, actionable, positive goals.
- Refrains from saying “there’s nothing more that we can do” or other similar phrases.
- Reassures patient that the clinician is still committed to caring for the patient, only with a shifted focus of the care.
Take a minute to think about what worked well in this example and what can be done differently.PRACTICE PHRASES
- “Based on what I know about you and what you want….I’d recommend that we not do CPR and just focus on your comfort.”
- “Absolutely it’s still important to protect your kidneys and eyes, that’s why we will do everything else we can to protect them, like controlling your blood pressure really well.”
Clayton JM, Butow PN, Arnold RM, Tattersall MH. Fostering coping and nurturing hope when discussing the future with terminally ill cancer patients and their caregivers. Cancer. 2005 May 1;103(9):1965-75.
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