Navigating Difficult Conversations

Navigating difficult conversations with pts can be daunting, especially if you have never seen someone do one well before. Conversations should follow a logical and sequential approach much like any procedure we perform in medicine. Like all procedures, practice makes us better.

• For difficult conversations that are not emergently required, do not rush.
• Remember: it may be on your to-do list, and it may feel routine, but many of these discussions are life-altering to pts and families.
• Before the conversation: provide yourself ample time to gather information (from specialists, literature, etc.) and to consider your approach to these discussions.
• During the discussion: make sure you are in a private area, that a pt has family members they do/do not want present, and you allocate time for questions.
• Good communicators have both formulated their message and identified which communication strategy to use before they initiate a conversation.
• Here are some suggestions for “Navigating Difficult Conversations”
  • Step 1. Determine your message—keep it simple and short (see Goals of Care section)
  • Step 2. Identify what type of news you are communicating: breaking bad news, assessing understanding of information, communicating prognosis, or navigating goals of care.
  • For references, view Vital TalkTM or scan the QR code below
  • Scan the QR Code to view video examples or search the Learning Exchange “Navigating Difficult Conversations With Pts” (requires VUMC login)