Serious Illness Conversations J. Keith Mansel, M.D.

The Conversation Project

Where is the knowledge we have lost in the information, And where is the wisdom we have lost in the knowledge T. S. Eliot “Chorus to a Rock” 1934

The many advances in modern medicine have led to opportunities that our parents and grandparents could not have imagined, yet, we have challenges. . .

The Conundrum…..

Where death happens

20% of all Americans die in an ICU

Hospital Systems and Continuity Challenges

The coming Tsunami of Baby Boomers

Communication Challenges: Conversing and Listening

Shared Decision Making

Shared Decision Making Non medical component Medical components

Clinical Picture

Big Picture What does this mean for you? Prognosis

What is important to you

Conversation Guide What is your understanding of the current state of your health? How to you like to receive your information? If your health worsens, what is most important to you (goals, hope)? What are your biggest fears and worries about the future of your health?

Conversation Guide…. - What complications or side effects are prohibitive to you? - What abilities are so critical that you can’t imagine living without them? - If you become sicker, how much are you willing to go through to gain more time? -How much does your family know about your priorities and wishes?

Conversation Guide….. - What makes life worth living for you? - How do you expect friends and family to support your decisions for your health? - How does independence or dependence affect your life? - Are you comfortable and safe in your surroundings?

Conversation Guide….. - How do your faith/beliefs affect your feelings toward serious illness? - What will be important to you when you are dying? - Where would you prefer to die? - How do you feel about suffering from an irreversible chronic illness and the use of life sustaining measures?

The Dignity Question What is the one thing your doctor needs to know about you to help care for you that you have not talked about?

And lastly……the Conversation - Incremental - Iterative - Change - Normative