Chapter 2: Assessment

Assessing medical and emotional needs

What the palliative care experts says
Dr. Mike Harlos explains how to approach having a conversation to determine what the family understands. (3:22)Video transcript

The nature of the medical event and the patient’s progression in their illness trajectory will influence assessments and diagnostics. Each case needs to be assessed individually and in consultation with the patient and family. Consider the medical needs and discuss the options and protocol deviations with all concerned.

Why was the 911 call made?

Often a change in health status precipitates the 911 call. Changes in symptoms can be troubling, particularly:

  • On evenings and weekends.
  • During business hours when their regular health team isn’t available.

  • If there’ll be a long wait before their health team can help.

Conversation Prompts

What prompted you to call 911? Did something new happen? Did a symptom worsen?

What do you understand about what’s happening now? Can you tell me what you think is going on?

Defining priorities

  • What is the medical need?
    • What new information will be provided about patient status?
    • Will that information inform treatment decisions?

  • What are the patient's goals?
    • Comfort?
    • Time with family?
  • What does the family need?
    • Reassurance that the patient is comfortable?
    • Are the family's needs in line with quality patient care?

Flexibility is needed when determining the course of action. For example, discussions might indicate that the family may benefit emotionally from a medically unnecessary assessment.

Involving the health team

It’s likely that the patient and family are connected to the healthcare system. Where possible, connect with a member of the health team that is supporting the patient to discuss the care plan, what’s happening medically, and to integrate your care with the care plan. 

Ask for the name and contact information of:

  • The primary care team. 
  • Other services involved, including home care. 

Location of care 

If symptoms can't be managed at home, discuss the preferred location of care with the patient and family. For many, the goal is to keep the person at home. 

For additional information, see Module 4, Decision-making and Module 6, Supporting the patient and family.