CURRENT Diagnosis &Treatment: Family Medicine, 5e >Hospice &Palliative Medicine

Jeannette E. South-Paul, Samuel C. Matheny, Evelyn L. Lewis+

Table 67–8.REMAP: addressing goals of care.

“Given these new findings, I would like to talk about what to do next.”

“You have been through a lot. I wonder if it makes sense to reevaluate what we are doing. I am
Reframe why the status quo is not working concerned that more treatments might do more harm than good.”

“You have been fighting very hard over the past few years. You tell me that you are getting
increasingly tired, and you struggle to do the things you enjoy. We are in a different place now.”

“What are you most concerned about?”

Expect and respond to emotions “I can see this is a shock. This is not what you expected.”

“This is difficult stuff to talk about.”

“Given that time is short, what is important to you?” (After an answer is given: “And what else is
important to you?”)

“What do you enjoy doing? What gives your life meaning?”

Map patient values

“What would you like to avoid?” (After an answer is given: “And what else would you like to avoid?”)

“When you think about your future, are there things you hope to do?”

“When you think about the future, what concerns you?”

Align with patient values “As I listen to you, it sounds like it is important to you to … .”

“Since you are hoping to make it to your granddaughter’s wedding in 2 months, I propose we enroll
you in a clinical trial. Should you experience significant side effects from the treatment and should your
weakness significantly worsen, I recommend that we stop the trial and rather focus on controlling your
symptoms very aggressively.”
Propose a treatment plan
“You want to focus on being comfortable. If your heart stops, we will not use machines to try to keep
you going and rather let you pass peacefully.”

“What do you think about all of this?”

Date of download: 12/27/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.