Transcript of Goals of Care Conversations Training Reframing: We’re in a Different Place.
- 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
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- Setting Perception Invitation Knowledge Empathize Name
Acknowledge Summarize/Strategize Review: Delivering Serious News
SPIKES
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- Since Last Time, Have You Delivered Serious News? What went
well? Any challenges?
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- Goals of Care: What Makes these Conversations Tough?
Expectations Uncertainty Emotions And the lack of a framework
within which to enter the conversation
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- What We Will Learn REMAP: A Talking Map for Goals of Care
Conversations
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- How We Will Learn Define skills (lecture) Observe skills in
action (videos) Practice (drills)
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- Reframe Expect emotion Map out whats important Align with
patient values Plan treatment to match patient values REMAP:
Discussing Goals of Care
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- 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
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- 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)
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- 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
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- 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)
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- 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)
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- REMAP: Reframe and Expect Emotion
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- What did you see?
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- Time to Practice!!
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- 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
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- 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
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- Drill: Swap Roles PatientClinician
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- How did it feel to say the words? One thing clinician noticed
One thing patient noticed Drill: Debrief
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- 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)
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- 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
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- 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?
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- How did it feel to say the words? One thing clinician noticed
One thing patient noticed Drill: Debrief 2
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- Where do you think youll get stuck? What do you want to take
forward?
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- 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.