1. TNEEL-NE Mr. Williams Case Study Stuart J. Farber, MD

2. Slide 2 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Mr. Williams is a 53-year-old heavy smoker. Seven months ago he had surgery to remove a segment of his lung for treatment of adenocarcinoma. He left the hospital with the surgeon’s assurances that he would make a "complete recovery.“ Recently, he has been readmitted because of progressive disease, and his distressing symptoms include shortness of breath, severe pain, weakness, and anorexia. Click image to play video clip. Mr. Williams Age 53 Heavy Smoker

3. Slide 3 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Less Effective Responses (Click the response text to play an audio clip) Blaming: I can't believe those doctors have done this again. It's just terrible. Rescuing/Solving the Problem: What you need to do is sit down with those doctors and tell them what it is you want for your father. I can't believe those doctors have done this again. It's just terrible. What you need to do is sit down with those doctors and tell them what it is you want for your father.

4. Slide 4 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Less Effective Responses (Click the response text to play an audio clip) Jumping to Conclusions: You need a pain consult. His pain management isn't working. You need a pain consult. His pain management isn't working. I'll call your doctor and sit with you while you talk with him.

5. Slide 5 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Less Effective Responses (Click the response text to play an audio clip) Feeling Helpless or Overwhelmed: I don't know what we can do about this. I don't know what we can do about this. When I get a chance, I'll read his chart to see if there's anything else we can do. I'll do what I can, but I have other patients. No response - Leaving the room.

6. Slide 6 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Effective Responses (Click the response text to play an audio clip) Help me understand what you mean by "It's really bad.” Share with me what the doctor has told you so far. It sounds as if you both have been having a rough time. Mr. Williams, what are your concerns? I'm glad I'm here too. I'm going to work with you to help your dad. Let's start with your helping me to understand exactly what your concerns are.

7. Slide 7 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams A hallway consult takes place regarding care plan. Click image to play video clip.

8. Slide 8 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Breaking bad news: Disease-based approach. Click image to play video clip.

9. Slide 9 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams Breaking bad news: Patient and family centered approach. Click image to play video clip.

10. Slide 10 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams DNR discussion: Patient-family centered Click image to play video clip.

11. Slide 11 Connections: Communication Case Studies: Mr. Williams TNEEL-NE Case Study: Mr. Williams DNR Discussion: Task centered Click image to play video clip.