Patient is conscious, competent, and willing to make decisions
Whenever possible, you want to engage the patient in conversations about goals of care and the treatment plan. They may or may not wish family members to participate. Take your time and be sure to listen carefully.
- If there are no existing documents, what are the patient's wishes and level of understanding about their condition?
- How much information does the patient wish to share with family members?
- How much information about interventions do family members wish to be given? (Some families will be calmer and more collaborative if you explain your interventions; others won’t wish to know what’s going on.)
“It’s my understanding that you’ve made some recent changes to your health care plans upon learning that your disease is progressing. Is that correct? Can you tell me more about that?”
“Have you had any discussion with your primary care team about advanced care planning or resuscitation orders?”
"Is there anyone else you’d like to be involved?"
“How do you picture your remaining time? What matters most to you?”
“Where would you feel the most comfortable spending your remaining time? At home? In a health facility?”
“What does a peaceful death mean to you?”
“What expectations do you have of me and my EMS team for your care today?”
"What’s important for me to know?"
“Do you have any further questions for me?”
"Would you like to discuss what I’m doing? Its okay if you prefer not to."
"Are you telling me you’d rather not discuss what I’m doing?"
"I’m going to give this
medication now. My goal is to help your wife be more comfortable and less agitated.
Do you have any questions?"