1. Goals of Care Conversations Training Mapping the Future: Clarifying Priorities

2. h Mapping the Future Clarifying Priorities

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

4. Reframe Expect emotion Map out what’s important Align with patient values Plan treatment to match patient values REMAP: Discussing Goals of Care

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

6. How would you respond? –“Are you sure we’ve tried everything?” –“There has always been another treatment that worked!” –“Are you saying we’re giving up?” Review: Expect Emotion 2

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

8. Review: How’s it Gone? What’s worked? What’s been challenging? Have you gotten stuck?

9. What We Will Learn Reframe Expect emotion Map out what’s important Align with patient values Plan treatment to match values

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

11. REMAP: Map Out What’s Important You must know the patient’s goals and values before creating a plan Only way to know is by asking If asked correctly, the question makes sense and isn’t scary

12. REMAP: Map Out What’s Important (examples) “Given this situation, what’s 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?”

13. REMAP: Map Out The Future

14. What did you see?

15. Time to Practice!!

16. 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

17. Drill: REMAP (Patient Knows Values) ClinicianPatient My children, because… (improvise) Given this situation, what’s most important?

18. Drill: REMAP (Patient Knows Values) ClinicianPatient It’s important to me that I don’t give up – I don’t want to look back and regret that I didn’t give it everything I had. (Improvise) Given this situation, what’s most important? I admire your fight, and I can see how important it is for you to know that you’re not giving up.

19. Drill instructions: Swap Roles PatientClinician

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

21. Drill: REMAP (Patient Not Sure) ClinicianPatient I’m not sure what to tell you. (Improvise) Given this situation, what’s most important? What if you start with what you’re enjoying in your life right now?

22. Drill: REMAP (Patient Not Ready) ClinicianPatient I don’t feel ready to decide. It’s hard… (Improvise) Given this situation, what’s most important? This is a tough situation for anyone.

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

24. Drill instructions: Swap Roles PatientClinician

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

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

27. REMAP: a talking map for goals of care –MAP out what’s important –Identifies worries; what patient wants to avoid What’s one thing you’re going to try this week? Summary: REMAP

28. 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.