Step

Sample Language

R

1) Reframe why the current plan isn’t working

(This may require breaking bad news of disease progression first).

“Given the new tumors we saw on your scan, I’d like to talk about next steps. Would that be ok?”

E

2) Expect emotion. Empathize with the patient

“It sounds like you’re feeling really shocked.”

“I can tell this isn’t what you were expecting to hear.”

“I can imagine how overwhelming this is.”

M

3) Map the future

“When you think about the future, are there things you’re worried about? Things you’re hoping for?”

“Given that time may be short, what’s most important to you now?”

A

4) Align with the patient’s values

“It sounds like the most important things are getting your pain under control and having good time at home with your children and dog.”

“What I’m hearing you say is that the time you’ve been spending in the hospital has been really difficult, and if we could get your pain under control you’d prefer to stay at home.”

P

5) Propose a plan that matches patient values

“Given what you’ve said, I propose that we start some medications to help get your pain under control so you can get home and spend good time with your family. I don’t think more chemotherapy is going to help you stay home or be comfortable. I think getting hospice on board would help with managing the pain while allowing you to stay home. What do you think?”