| Conversation Guide | Starters |
|---|---|
| Understanding | What is your understanding now of where you are with your heart? |
| Information preferences | How much information about what is likely to be ahead with your heart would you like to know? How much do you want to be involved in making decisions about your HF care? |
| Prognosis | Share prognosis tailored to information preferences |
| Goals | If you heart worsens, share are your most important goals? |
| Fears/Worries | What are your biggest fears and worries about the future with your heart? |
| Function | What abilities are so crucial to your life that you can’t imagine living without them? |
| Tradeoffs | If you become sicker, now much are you willing to go through for the possibility of gaining more time? |
| Family | How much does your family know about your priorities and wishes? |
| Conversation Flow | |
|---|---|
| Set up the conversation -Introduce foals of care and benefits |
I am hoping we can talk about where things are with your heart and where they might be going. Given your recent hospital stay, we are in a different place now. It seems like a good time to talk about what now. Is this OK? |
| Assess understanding and information preferences | What is your understanding now of where you are with your heart? How much information about what is likely to be ahead with your heart would you like to know? |
| Share prognosis -Tailor information -Allow silence, explore emotion |
I am worried that time may be short or this may be as strong as you get. |
| Explore key topics | What are your most important goals if your health worsens? What are your biggest fears and worries about your future health? What gives you strength as you think about the future? What abilities are critical to you? If you become sicker, how much are you willing to undergo to gain more time? |
| Close conversation - Summarize what you heard - Make a recommendation - Affirm your commitment to the patient |
It sounds like, XXX is very important to you. Given your goals and priorities, and what we know about your heart condition, I recommend XXX. Here is what I can do now that will help you get those important things. Overall, my experience tells me that more XXX would do more harm than good at this point. We are in this together. |
| Document the conversation in medical record. | |
| Assist patient in completing advance directive, if appropriate. | |