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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
Since Last Time, Have You Delivered Serious News? What went
well? Any challenges?
Slide 6
Goals of Care: What Makes these Conversations Tough?
Expectations Uncertainty Emotions And the lack of a framework
within which to enter the conversation
Slide 7
What We Will Learn REMAP: A Talking Map for Goals of Care
Conversations
Slide 8
How We Will Learn Define skills (lecture) Observe skills in
action (videos) Practice (drills)
Slide 9
Reframe Expect emotion Map out whats important Align with
patient values Plan treatment to match patient values REMAP:
Discussing Goals of Care
Slide 10
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
Slide 11
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)
Slide 12
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
Slide 13
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)
Slide 14
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)
Slide 15
REMAP: Reframe and Expect Emotion
Slide 16
What did you see?
Slide 17
Time to Practice!!
Slide 18
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
Slide 19
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
Slide 20
Drill: Swap Roles PatientClinician
Slide 21
How did it feel to say the words? One thing clinician noticed
One thing patient noticed Drill: Debrief
Slide 22
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)
Slide 24
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
Slide 25
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?
Slide 26
How did it feel to say the words? One thing clinician noticed
One thing patient noticed Drill: Debrief 2
Slide 27
Where do you think youll get stuck? What do you want to take
forward?
Slide 28
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.