Discussing Prognosis: Using the ADAPT tool to guide you through complex conversations
We designed this talking map to give you a just-in-time route through a complex conversation. Think of it as a series of signposts—you might find that not all apply to a particular patient.
|Step||What you say|
|1. Ask what the patient knows, what they want to know||What have other doctors told you about what your prognosis, or the future?
How much have you been thinking about the future?
|2. Discover what info about the future would be useful for the pt||For some people prognosis is numbers or statistics about how long they will live.
For other people, prognosis is about living to a particular date. What would be more helpful for you?
|3. Anticipate ambivalence||Talking about the future can be a little scary.
If you’re not sure, maybe you could tell me how you see the pros and cons of discussing this.
If clinically deteriorating: From what I know of you, talking about this information might affect decisions you are thinking about.
|4. Provide information in the form the patient wants||To provide using statistics:
The worst case scenario is [25th percentile], and the best case scenario is [75th percentile].
If I had 100 people with a similar situation, by [median survival], 50 would have died of cancer and 50 would still be alive with cancer.
To provide without statistics:
From my knowledge of your situation and how you cancer has been changing /responding, I think there is a good/50-50/slim chance that you will be able to be around [on that date/for that event].
|5. Track emotion||I can see this is not what you were hoping for.
I wish I had better news.
I can only imagine how this information feels to you. I appreciate that you want to know what to expect.
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