Communication and Shared Decision Making / Acute Care / Settings of Care / Health Professionals

Communication is the start of palliative care

Communication with patients at end of life and their family, carers and other chosen support people is essential for planning and decision making about current and future care. These conversations are not easy. Training and discussion prompts can help with skill development.

Related Evidence

CareSearch decision making systematic literature reviews

While many hospitals have fact sheets about communication these additional resources may help when discussing end of life:

Frameworks and mnemonics

The REMAP framework (Reframe, Expect emotion, Map out patient goals, Align with goals, and Propose a plan) encourages health professionals to remain flexible and adapt their recommendations based on what they hear from the patient. It is focused on shared decision making with ongoing revision leading to patient centred decisions. [1]
VitalTalk provide evidence-based training to develop communication skills to navigate tough conversations more easily.
PREPARED (186kb pdf) is a set of clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their carers.
SPIKES (106kb pdf) is a six-step process for delivering bad news.
The Nurse mnemonic (106kb pdf) to respond to emotional cues.
MVP – Medical Situation, Values, and Plan (medical situation, values and plan) model for all serious illness conversations.

Conversation guidance

Health professionals may find the Advance Care Planning Australia conversation starters a great way to begin discussions about patient values, beliefs and health care preferences to initiate advance care planning.
End-of-Life Essential toolkit (644kb pdf) contains an action checklist for patient-centred communication and shared decision making.

Shared decision making

Communication with patients, families and carers about end-of-life care involves shared decision making which includes: introducing choice, describing options, often by integrating the use of patient decision support, and helping patients explore preferences and make decisions. [2] The Australian Commission on Safety and Quality in Health Care has many different resources that can help with shared decision making.

The Cognitive Decline Partnership Centre, Supporting Decision making guide was developed for people living with dementia, family members and carers support people living with dementia to make decisions about their care.

Visit End-of-Life Essentials patient-centred communication and shared decision making module.

Shared decision-making module

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.
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361-7. doi: 10.1007/s11606-012-2077-6. Epub 2012 May 23.