The clinician-patient dialogue about end-of-life treatment should start with a discussion with the patient focused on the question, “How can we help you live well?”
The goal of the living well interview is to elicit the patient’s perspective regarding how they want to spend their remaining time. Treatment decisions are then discussed, taking into consideration the patient's goals and hopes, and treatments or resources necessary to achieve them.
The living well discussion
. Soon after the diagnosis of a life-limiting condition.
. Health care professionals (e.g., physician, social worker, chaplain, nurse, psychologist, etc.), the patient, and family.
: The initial goal is to understand the patient’s hopes and goals, not to develop a specific medical plan. Physicians, chaplains, social workers, psychologists, etc. can team up to achieve a broad perspective of the patient’s views. Specific treatment decisions are made only after understanding the patient’s goals.
What to say
“Given what we now know about your medical condition…
- "How can we help you live well? What makes you happy?"
- "What activities or experiences do you need to maintain or fulfill for you to feel that your life has quality, or for you to live well?"
- "What fears or worries do you have about your illness or medical care?"
- "If you had to choose, would you want us to focus on helping you live longer, even if that made you feel worse, or on feeling well, even if that meant you may not live as long?"
- "What needs or services would you like to discuss?"
- "What do you hope for your family?"
- "Are there any special events or activities that you are looking forward to?"
- "What sustains you when you face serious challenges in your life?"
- "Do you have religious or spiritual beliefs that are important to you?"
- "In what way do you feel you could make this time especially meaningful to you?"
- "Most medical care is about making small sacrifices in the interest of improving your health for tomorrow. But considering your underlying illnesses, I am hoping you can guide me in helping you make today a better day for you.”
See reference for more information.
Adapted from Ambuel B. Establishing end-of-life goals: the living well interview. Palliative Care Network of Wisconsin. Fast facts and concepts #65. Bleeding management in hospice settings. Internet. Accessed on May 4, 2018.