Set up the conversation
"I'd like to talk about what is ahead with your illness and do some thinking in advance about what is important to you so that I can make sure we provide you with the care you want — is this okay?"
Assess understanding of prognosis
"What is your understanding now of where you are with your illness?"
"How much information about what is likely to be ahead with your illness would you like from me?"
Share prognosis
"I want to share with you my understanding of where things are with your illness..."
Uncertain: "It can be difficult to predict what will happen with your illness. I hope you will continue to live well for a long time but I'm worried that you could get sick quickly, and I think it is important to prepare for that possibility."
Or
Time: "I wish we were not in this situation, but I am worried that time may be as short as… (express as a range, e.g. days to weeks, weeks to months, months to a year)."
Or
Function: "I hope that this is not the case, but I'm worried that this may be as strong as you will feel, and things are likely to get more difficult."
Explore key topics
"What are your most important goals if your health situation worsens?"
"What are your biggest fears and worries about the future with your health?"
"What gives you strength as you think about the future with your illness?"
"What abilities are so critical to your life that you can't imagine living without them?"
"If you become sicker, how much are you willing to go through for the possibility of gaining more time?"
"How much does your family know about your priorities and wishes?"
Close the conversations
"I've heard you say that ___ is really important to you. Keeping that in mind, and what we know about your illness, I recommend that we ___. This will help us make sure that your treatment plans reflect what's important to you."
"How does this plan seem to you?"
"I will do everything I can to help you through this."
Document your conversation
Use the dot phrase ".SICP."
Communicate with key clinicians
Share appropriate outcomes from your conversation.