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Goals of Care Conversations Training Mapping the Future: Clarifying Priorities

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h Mapping the Future Clarifying Priorities

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Goals of Care Conversations: A Five Part Series 1Delivering Serious News 2Reframing: Were in a Different Place 3Mapping the Future: Clarifying Priorities 4Aligning with Patient Values 5Conducting a Family Meeting

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Reframe Expect emotion Map out whats important Align with patient values Plan treatment to match patient values REMAP: Discussing Goals of Care

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Given where you are in your illness, it seems like a good time to talk about where to go from here Were in a different place than we were [X] months ago REMAP: Reframe (examples)

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How would you respond? Are you sure weve tried everything? There has always been another treatment that worked! Are you saying were giving up? Review: Expect Emotion 2

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Ask permission to transition to next topic Is it okay if we talk now about where we go from here? Review: Expect Emotion 2

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Review: Hows it Gone? Whats worked? Whats been challenging? Have you gotten stuck?

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What We Will Learn Reframe Expect emotion Map out whats important Align with patient values Plan treatment to match values

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How We Will Learn Define skills (lecture) Observe skills in action (videos) Practice (drills)

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REMAP: Map Out Whats Important You must know the patients goals and values before creating a plan Only way to know is by asking If asked correctly, the question makes sense and isnt scary

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REMAP: Map Out Whats Important (examples) Given this situation, whats most important to you? Knowing that time may be limited, are there things you want to do? As you think about the future, what are you worried about?

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REMAP: Map Out The Future

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What did you see?

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Time to Practice!!

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Review drill as a group Divide into pairs to practice the drill Practice the drill script (person with bigger feet goes first) Switch roles Debrief with one another: How did it feel to say the words? One thing clinician noticed One thing patient noticed Drill Instructions

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Drill: REMAP (Patient Knows Values) ClinicianPatient My children, because (improvise) Given this situation, whats most important?

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Drill: REMAP (Patient Knows Values) ClinicianPatient Its important to me that I dont give up I dont want to look back and regret that I didnt give it everything I had. (Improvise) Given this situation, whats most important? I admire your fight, and I can see how important it is for you to know that youre not giving up.

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Drill instructions: Swap Roles PatientClinician

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How did it feel to say the words? One thing clinician noticed One thing patient noticed Drill: Debrief

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Drill: REMAP (Patient Not Sure) ClinicianPatient Im not sure what to tell you. (Improvise) Given this situation, whats most important? What if you start with what youre enjoying in your life right now?

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Drill: REMAP (Patient Not Ready) ClinicianPatient I dont feel ready to decide. Its hard (Improvise) Given this situation, whats most important? This is a tough situation for anyone.

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Drill: REMAP (What is Patient Worried About?) ClinicianPatient Im afraid of being in pain all the time. (Improvise) As you think about the future, is there anything you worry about? Thats a normal thing to be scared of. We will do everything we can to keep you comfortable.

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Drill instructions: Swap Roles PatientClinician

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How did it feel to say the words? One thing clinician noticed One thing patient noticed Drill: Debrief 2

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What surprised you? What do you want to take forward? Anywhere you may get stuck?

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REMAP: a talking map for goals of care MAP out whats important Identifies worries; what patient wants to avoid Whats one thing youre going to try this week? Summary: REMAP

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Goals of Care Conversations Goals of Care Conversations training materials were developed and made available for public use through a U. S. Department of Veterans Affairs contract with VitalTalk. [Order VA777-14-P-0400] Materials are available for download from VA National Center for Ethics in Health Care at vaww.ethics.va.gov/goalsofcaretraining.asp.