Talking about goals of care is the pivotal communication task when you are caring for a patient with serious illness & their family. The terminology has changed even since our book was published—back then we called it a ‘transition’ conversation—but since then, we’ve decided to put the focus of the task on what a clinician discovers about their patient’s values, goals, and fears. After you have done that, the work of creating a plan that honors those values, goals, and fears is what follows, equally important, and often easier.
Our talking map for this task, REMAP, is meant to signal a possible change in direction, and it has been optimized for what we now think of as a ‘late‘ goals of care conversation, where a clinical decision is needed. [To us, an ‘early‘ goals of care conversation is one where a clinical decision is not imminent.]
Note that if your patient doesn’t understand their medical situation, you need to establish a degree of understanding first. [In our workshops, we sometimes include the principles of giving serious news in the first two steps of REMAP, but if you haven’t seen those videos you should check them out, use our app, or try our online course.]
Then you will find that REMAP reminds you to map the patient’s values and goals before you go on to offer a plan, or a recommendation. Why? For your patient to sign on to a new direction, the care plan you offer must reflect their values explicitly. You have to create a conversational space that is safe.
So tune up your empathy skills, and remember: they’re doing the best they can. And do not hesitate to draw on a mentor or partner, because this is one of the hardest conversations to do really well.