Source: Health Quality and Safety Commission
A new evidence-based guide to support clinicians to have quality conversations with seriously ill people and their whānau is now available.
Serious illness conversation guide Aotearoa is a framework for best communication practices to structure and support shared decision-making practice.
The Commission’s senior programme manager advance care planning and clinical communication training, Leigh Manson, says research shows that when health professionals avoid discussing prognosis, what really matters to the patient and end-of-life issues, it is often because they feel uncomfortable having these conversations.
‘The guide will be particularly useful to help clinicians who don’t come from a palliative care background to have conversations with seriously ill people and their whānau about what would be most important to them if time were limited or their functional abilities were to change.’
The guide is based on one developed by Ariadne Labs, an American non-profit centre for health systems innovation founded by surgeon, writer, and public health leader, Atul Gawande. It has been adapted for New Zealand by consumers and clinicians using codesign principles.
It uses patient-tested language and explores:
- the person’s understanding of their illness
- their preference for information
- the sharing of a prognosis (this may be time passed, functional or uncertain)
- an exploration of the person’s:
- fears or worries
- the abilities they find most important
- the trade-offs they are willing to make for the possibility of more time
- how much their whānau know.
It culminates with shared planning and agreeing next steps which are consistent with the person’s values and goals.
Ms Manson says research supports the approach being taken in New Zealand of training clinicians to be trainers who then deliver three-hour serious illness conversation guide workshops in their local DHBs. The workshops use role play to support clinicians to use the guide in conversations with their patients and whānau.
‘We have seen a significant increase in clinicians’ confidence to have these conversations after attending the workshops. So, as well as encouraging clinicians to use the guide with their patients, I would urge them to seek out this training in their region.’
Ms Manson says research has identified many barriers to communication, including lack of knowledge about how to approach end-of-life communication, variation in attitudes about the right time to start, time constraints and worries about patient reluctance.
But she says research also shows that avoiding these conversations or only initiating them late in the course of a disease can lead to poorer patient quality of life, anxiety, family distress, a prolonged dying process, unwanted and unwarranted treatments, patient mistrust of the health system and seriously ill patients not receiving the care they desire.
‘We know effective communication plays a major role in helping patients adapt to the realities of their illness, and to make appropriate decisions to achieve best quality of life throughout the trajectory of a serious illness.
‘The evidence is that patients and families want open, honest communication and a balance between realistic information and appropriate hope. We therefore should be supporting patients and their whānau to make better treatment and care choices by including what is important to them, their values, preferences and goals into the decision-making process.’