Leading with the Headline: Serious Illness Conversations in the ED

Contributors: Dillon Warr, MD and Neena Kashyap, MD

In this episode, we discuss a procedure so impactful that it can influence the direction of care and the patient’s subsequent hospital course. This procedure is the act of having a serious illness conversation. We talked to Dr. Neena Kashyap, an emergency medicine trained and now palliative care fellow at Cooper University Hospital. After today’s discussion, we hope that you will be better prepared to engage patients and their families in these often difficult conversations.

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Key Points

Prepare a Headline before you enter the patient’s room. This headline is a short, succinct, medical-jargon-free summary of the patient’s medical status and what the implication of this medical status is for the patient.
We can apply the principles of engaging in these serious illness conversations across multiple conditions and situations–think broadly about what “life altering news” means.
We can control the process and not necessarily the outcome in these situations–shift your mindset to allow the patient to shift their own.
Shut up and be curious. Let the patient and/or family process their emotions and explore their values through active listening and targeted, probing questions.
It is okay in these situations to be compassionately paternalistic–we’ve trained for this and should be empowered to make treatment recommendations that align with their values.

REMAP Framework for Serious Illness Conversations. It allows you to discuss prognosis, respond to patient emotion, explore values, and often make a recommendation for medical treatments that fit those values.

The NURSES mnemonic is used to leverage empathy to respond to and to accept the patient’s emotions during serious illness conversations.

Vital Talk

VitalTalk is the premier training organization for clinicians seeking to advance their communication skills. Just as no one is born knowing how to handle a scalpel, the same is true for how to communicate effectively with seriously ill patients and their families.

Main Website: https://www.vitaltalk.org/

Courses: https://chooseyourpath.vitaltalk.org/

References

Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: A Framework for Goals of Care Conversations. J Oncol Pract. 2017 Oct;13(10):e844-e850. doi:10.1200/JOP.2016.018796. Epub 2017 Apr 26. PMID: 28445100
Childers JW, Bulls H, Arnold R. Beyond the NURSE Acronym: The Functions of Empathy in Serious Illness Conversations. J Pain Symptom Manage. 2023 Apr;65(4):e375-e379. doi: 10.1016/j.jpainsymman.2022.11.029. Epub 2022 Dec 12. PMID: 36521764; PMCID: PMC10883350.
Back AL, Arnold RM, Baile WF, Tulsky JA, Fryer-Edwards K. Approaching difficult communication tasks in oncology. CA Cancer J Clin. 2005 May-Jun;55(3):164-77. doi: 10.3322/canjclin.55.3.164. PMID: 15890639.