The document discusses effective communication strategies at the end of life, particularly in the context of critical care and family meetings. It highlights challenges such as poor understanding of diagnosis and prognosis among families and emphasizes the importance of empathy, shared decision-making, and clear communication. The content suggests that communication can indeed be taught and improved through structured approaches.

1. 10
Communication at the End of Life
SMACC 2015
Chicago
#smaccUS
#FOAMcc
#HPM @expensivecare

2. 10
Communication at the End of Life
SMACC 2015
Chicago
#smaccUS
#FOAMcc
#HPM @expensivecare

3. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Abe
The Patient

4. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Dr. Nick
The Doctor

5. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Homer
Marge
Bart
Lisa
Maggie
The Family

6. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
The Family Meeting

7. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Hi everybody!
The Patient has septic shock with
an unclear source.
His MAP is 60 on an infusion of
40mcg/kg/min of noradrenaline. He
has a lactate of 9 and a bicarb of
12.
He’s anuric and his creatinine is
350.
Do you want us to do everything?
The Family Meeting

9. Is there a problem?

10. Is there a problem?
Can communication be taught?

11. Is there a problem?
Can communication be taught?
What do the experts do?

12. Is there a problem?
Can communication be taught?
What do the experts do?
What about the difficult situations?

14. 22% of Americans die in ICU

15. 22% of Americans die in ICU
90% following planned
withdrawal of care

16. 22% of Americans die in ICU
90% following planned
withdrawal of care
54% of families have poor
understanding of diagnosis, plan
and prognosis
Levin GenHospPsych 2010

17. hellomynameis.org.uk

18. Family Talking
Doctor Talking
McDonagh CCM 2004

19. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use.
The Medical Expert
TheValues Experts

20. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use.
The Medical Expert
TheValues Experts
Turnbull CCM 2014;
Schneunemann CCM 2015
Autonomy

21. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use.
The Medical Expert
TheValues Experts
Turnbull CCM 2014;
Schneunemann CCM 2015
Autonomy
Substituted Judgement

22. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use.
The Medical Expert
TheValues Experts
Turnbull CCM 2014;
Schneunemann CCM 2015
Autonomy
Substituted Judgement
Best Interests

23. Doctor Decides
Patient Decides
Patient Preferences
for decision making
Doctor Decides
Shared
Surrogate Decides
Surrogate Preferences
for decision making
Johnson AJRCCM 2011
Chung JME 2011

24. Is communication a
clinical skill?
Image: lifeinthefastlane.com

25. Hope AATS 2015

26. McAllister AATS 2015
Hope AATS 2015

27. McAllister AATS 2015
Hope AATS 2015
Curtis JAMA 2013

28. Value
Acknowledge
Listen
Understand
Elicit
Lautrette NEJM 2007

29. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Dr. Hibbert
The Expert
Communicator

30. Plan the meeting

31. image: wikimedia commons
Introductions
&
Agenda

33. Swayden PEC 2012
Standing Sitting

34. 1:28
Swayden PEC 2012
Standing Sitting

35. 1:28
3:44
Swayden PEC 2012
Standing Sitting

36. 1:28
3:44
1:04
Swayden PEC 2012
Standing Sitting

37. 1:28
3:44
1:04
5:00
Swayden PEC 2012
Standing Sitting

38. image: nytimes.com
The Medical Bit

39. image: nytimes.com
Gather
Understanding
The Medical Bit

40. image: nytimes.com
Fire a
warning shot
The Medical Bit

41. image: nytimes.com
No Jargon
The Medical Bit

42. image: nytimes.com
Hear from
everyone
The Medical Bit

43. image: nytimes.com
Use the
“D-Word”
The Medical Bit

44. image: nytimes.com
Listen
The Medical Bit

45. image: smh.com
Make the patient’s
voice heard
TheValues Bit

46. Empathy
[em-puh-thee]
noun
1. The intellectual identification with or
vicarious experiencing of the feelings,
thoughts, or attitudes of another.
2. The imaginative ascribing to an object, as
a natural object or work of art, feelings or
attitudes present in oneself.

47. image: pressherald.com
MakeYOUR recommendation

48. image:Wellcome images
Reflect

49. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use; wikimedia commons
Herb
The son from
California
Molloy JAGS 1991

50. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use; wikimedia commons
Herb
The son from
California
Molloy JAGS 1991
Explore

51. Images: fox.com © Fox corporation 2015. For educational use under terms of fair use; wikimedia commons
Herb
The son from
California
“I wish….”
Molloy JAGS 1991
Explore

52. image: wikimedia commons

53. Image: fox.com © Fox corporation 2015. For educational use under terms of fair use.
Rev. Lovejoy
Pastoral Care

54. @expensivecare #smaccUS

55. @expensivecare
Is there a problem?
#smaccUS

56. @expensivecare
Is there a problem? Can communication be taught?
#smaccUS

57. @expensivecare
Is there a problem?
What do the experts do?
Can communication be taught?
#smaccUS

58. @expensivecare
Is there a problem?
What do the experts do?
What about the
difficult situations?
Can communication be taught?
#smaccUS