Table 3.

Summary of recommendations when discussing prognosis and end of life issues – adapted from Clayton et al, Bernaki and Block, and Royal College of Physicians guidance18–20

RecommendationThings to consider and examples of useful phrases
Conversations about the future can be conducted at any point of an illnessN/A
Show empathy, care and compassionN/A
Use clear language and deliver information at a suitable pace tailored to each individualN/A
Prepare for the discussionEnsure you have adequate knowledge of the case, allocate adequate time for the discussions, find a suitable environment, and establish who should be present
Assess what the patient and care giver already know and level of detail they want‘What is your understanding of your health situation and what is likely to happen?’
‘Some people like to know what may happen in the future, some want to know about time, others prefer not to know too many details. What do you prefer?’
Explain the uncertainty in prognostic information and avoid giving exact time frames‘Every person is different. I can only tell you what usually happens to people in your situation, not exactly what will happen.’
‘Statistics only help us understand the big patterns of illness, not exactly what will happen for an individual with that illness.’
Consider that caregivers’ information needs may require a separate meeting (provided the patient consents to this, if they have mental capacity)‘Often [daughters/sons] like to ask some other questions. Is it okay if I answer your [son's/daughter's] questions? Is there anything I should not discuss?’
Ensure explanation of ongoing support and continued care‘We've been talking about some treatments that are not going to be effective now and that we don't recommend. But there are a lot of other things we can still do to help and support you to make sure we maximise your function and comfort.’
Acknowledge and explore emotions, goals, and concerns‘If your health situation worsens, what are your most important goals?’
Encourage questions and check understandingN/A