The Arc of Conversation

Intending to fill an important gap in medical training, this book presents an easy-to-learn, standardized approach to having compassionate and collaborative goals of care conversations with patients and families, a skill that can be difficult for clinicians to learn and that is not part of standard medical education curricula. Developed by a Palliative Care provider, this is the first book to teach everything clinicians need to know to gently guide patients and families through what can often be difficult discussions about illness, disease, end-of-life wishes, and hospice care. This technique can be used to discuss any medical diagnosis or treatment, be employed at any age or stage of an illness, and can be used by health care professionals at any level. Readers will be introduced to the patterns of decline patients follow toward the end of life, criteria for recognizing when a patient’s time is limited, hospice care, ground rules for compassionate communication, and a step-wise method of leading patients and families through difficult goals of care conversations in a collaborative way. The book includes specific questions to ask and starter language clinicians can use for developing their own patient-friendly talking points about disease progression, the end of life, concerns that a patient’s time is limited, advanced directives, code status, and hospice care. An Arc of Conversation Guide, for use when learning this technique, is included in the Appendix. While modern medicine is terrific at acute stabilization of illness or injury, it often ignores the elephant in the room—disease progression and death. By doing so, the healthcare system frequently misses opportunities to align patient wishes with the care they receive. Furthermore, physicians often avoid difficult conversations with patients due to a lack of training or the assumption that hospice care represents medical or personal failure. Incorporating the material and technique taught in The Arc of Conversation into everyday practice will enable clinicians to acknowledge and discuss patient decline and to confidently include hospice care as a viable option for treatment that can support patient values, wishes, and priorities. Moving toward a continually collaborative approach with patients—a shift away from physician-directed care to patient-centered care—will enable clinicians to develop treatment plans that prioritize outcomes that matter most to patients and families, improving patient and family experience of health care across their lives and providing patients with the ‘soft landing’ they want at the end.