Not Achievable with health status

Troubleshooting: Common Challenges In Aligning Decisions With Patients’ Health Priorities

Challenge: The patient’s health outcome goals are not achievable and realistic given their health status and trajectory

A patient may want to achieve a goal that you feel is not realistic given their current health status and most likely health trajectory.

Scripts

Explore Patient’s Understanding:
“How do you think the next year or few years will be for you in terms of your health and function?”

“What is your understanding of how your illnesses will affect your day to day life, and your health?”

Share Your Understanding:
“In my experience, in working with people with similar conditions to yours, we can expect (expected trajectory including life expectancy, functional trajectory, hospitalizations, etc). How does this change the way you think about what matters most to you”

Scripts

Mrs. B has had several hospitalizations for CHF and has declined functionally after each.

“I know in the past, your goal has been (health outcome goal), but as time has gone by and you have had a number of changes in your health. We are in a different place now.”

“I worry that we can’t achieve (health outcome goal). I wonder if there are other ways to fulfill your (underlying value) that could be more achievable”

Scenario

“I know in the past, your goal has been to volunteer in the library, but as time has gone by you have had a number of changes in your health. We are in a different place now. Let’s think about other ways we can help you to feel engaged in your community.”