How the second conversation worked in practice
| The first conversation | Setting | Conversations took place during and after ward rounds, during on-call shifts or when the facilitator was on the ward supervising the junior doctor. |
| Topic of discussion | A range of topics were discussed in the first conversation:
> clinical deterioration and poor prognosis > resuscitation decisions > new ceiling(s) of treatment > complex discharge > other areas relating to advance care planning. | |
| Training/education component | Where possible, a short discussion took place between the facilitator and junior doctor following the first conversation, which lasted between a few minutes to half an hour. This was used by junior doctors to ask questions and prepare and plan how to approach the second conversation. | |
| The second conversation | Timing | Second conversations took place on the same day or a few days after the first conversation. There was one exception, which took place after two weeks (where the first conversation had taken place during an on-call shift). |
| Setting | Conversations were arranged in advance and usually took place either on the ward (face-to-face), though some were done by telephone for the patient or caregiver's convenience.
> Three conversations were with the patient alone. > One conversation was with the patient and their caregiver. > Seven conversations were with the caregiver alone. | |
| Facilitator observation | The second conversations were usually not observed. | |
| Topic of discussion | Depending on the patient/caregiver's wishes and needs, the second conversation allowed time to revisit the first discussion and clarify understanding and answer any new questions. | |
| Training education component: debrief | Conversations were followed by informal or formal ‘debriefs’ which varied in length, depth and structure. | |
| Evidencing learning, skills development and reflection | Junior doctors were able to use the Second Conversation as an opportunity to evidence curriculum items in their e-portfolio, in the form of a supervised learning event or structured reflection. |